LB 3403 
1912a 
Copy 1 



UNITED STATES BUREAU OF EDUCATION 

BULLETIN. 1913. NO. 18 WHOLE NUMBER 528 



THE FIFTEENTH INTERNATIONAL 
CONGRESS ON 

HYGIENE AND DEMOGRAPHY 

HELD IN WASHINGTON. D. C. 
FROM SEPTEMBER !6 TO OCTOBER 5. 1912 



I. Some Lessons and Suggestions from the Exhibition 
By FLETCHER B. DRESSLAR 

Specialist in School Hygiene and Sanitation 
Bureau of Educatbn 

II. Digests of Some of the Papers Presented at the Congress 




WASHINGTON 

GOVERNMENT PRINTING OFFICE 

1913 



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BULLETIN OF THE BUREAU OF EDUCATION. 

[Note. — With the exceptions indicated, the documents named below will be sent free of charge upon 
application to the Commissioner of Education, Washington, D. C. Those marked with an asterisk (♦) are 
no longer available for free distribution, but may be had of the Superintendent of Documents, Government 
Printing Oflace, Washington, D. C, upon payment of the price stated. Documents marked with a dagger 
(t) are out of print. Titles are abridged.) 

10O8. 

*No. 1. On the training of persons to teach agriculture. L. H. Bailey. 10 centa. 
tNo. 2. List of publications of the United States Bureau of Education, 1867-1907. 

Bibliography of education for 1907. J. I. Wyer, jr., and Martha L. Phelps. 

Music education in the United States. Arthur L. Manchester. 10 cents. 

Education in Formosa. Julean H. Arnold, American consul at Tamsui. 

The apprenticeship system, Carroll D. Wright. 15 cents. 

State school systems: Oct. 1, 1906, to Oct. 1, 1908. E. C. Elliott. 30 centa. 

Statistics of State universities, etc., 1907-8. 

1909. 

FaciUties for study and research in Washington. Arthur T. Hadley. 

Admission of Chinese students to American universities. John Fryer. 

Daily meals of school children. Caroline L. Hunt. 10 cents. 

The teaching staff of secondary schools. E. L. Thorndike. 10 cents. 

Statistics of public, society, and school libraries in 1908. 

Instruction in the fine and manual arts. Henry T. Bailey. 15 cents. 

Index to the reports of the Commissioner of Education, 1867-1907. 

A teacher's professional library. Classified list of 100 titles. 5 cents. 

Bibhography of education for 1908-9. 

Education for eflSciency in railroad service. J. Shirley Eaton. 

Statistics of State imiversities, etc., 1908-9. 5 cents. 

1910. 

No. 1. Reform in teaching religion in Saxony. Arley Barthlow Show. 

No. 2. State school systems: October 1, 1908, to October 1, 1909. E. C. Elliott. 
tNo. 3. List of publications of the United States Bureau of Education, 1867-1910. 

No. 4. The biological stations of Europe. Charles Atwood Kofoid. 

No. 5. American schoolhouses. Fletcher B. Dresslar. 
*No. 6. Statistics of State universities, etc., 1909-10. 5 cents. 

1911. 

Bibliography of science teaching. 5 cents. 

Opportunities for graduate study in agriculture. A. C. Monahan. 

Agencies for improvement of teachers in service. W. C, Ruediger. 15 cents. 

Report of the commission to study the public schools of Baltimore. 10 cents. 

Age and grade census of schools and colleges. George Drayton Strayer. 

Graduate work in mathematics in universities. 

Undergraduate work in mathematics in colleges and universities. 

Examinations in mathematics. 

Mathematics in technological schools of coUegiate grade. 

Bibhography of education for 1909-10. 

Bibhography of child study for the years 1908-9. 10 cents. 

Training of teachers of elementary and secondary mathematics. 

Mathematics in elementary schools. 

Provision for exceptional children in the pub He schools. 

The educational system of China as recently reconstructed. H. E. King. 

Mathematics in public and private secondary schools. 

List of pubhcations of the U. S. Bureau of Education, October, 1911. 5 cents. 

Teachers' certificates (laws and regulations). Harlan Updegraff. 

Statistics of State universities, etc., 1910-11. 

(Continued on page 3 of cover.) 



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UNITED STATES BUREAU OF EDUCATION 

BULLETIN, 1913. NO. 18 WHOLE NUMBER 528 



THE FIFTEENTH INTERNATIONAL 
CONGRESS ON 

HYGIENE AND DEMOGRAPHY 

HELD IN WASHINGTON. D. C. 
FROM SEPTEMBER 16 TO OCTOBER 5. 1912 



I. Some Lessons and Suggestions from the Exhibition 
By FLETCHER B/DRESSLAR 

Specialist in School Hygiene and Sanitation 
Bureau of Education 

II. Digests of Some of the Papers Presented at the Congress 




WASHINGTON 

GOVERNMENT PRINTING OFFICE 

1913 

;1 / 



D. OF D. 
JUN 25 1913 



^'> 



ix 



v^^>" 



■MMMMiMMMMl 



COlSTTElsTTS. 



Page. 

Letter of transmittal 5 

Introduction 7 

PART I. 

School buildings and school sanitation 9 

Glass blackboards 11 

Drinking fountains 11 

The Forsyth Dental Infirmary for Children 12 

Dental clinic 13 

Spiral fire escape 13 

The dust problem 14 

Cleaning and humidifying the air 15 

Sanitary toilets 16 

School desks 17 

Hygiene and tuberculosis 18 

The value of pure air 18 

Open-air schools and open-air sleeping rooms 19 

Boy Scouts 22 

Industrial hygiene 23 

Nourishment of children 26 

Mental hygiene 28 

Sex hygiene 35 

Experimental psychology 38 

The Cornell exhibit 38 

Appendix. — Instructions relating to tuberculosis, distributed by the depart- 
ment of health, New York City 40 

PABT II. ABSTRACTS OF PAPERS BEARING ON EDUCATION. 

Ringworm in the schools of Mexico. By Dr. Manuel Uribe y Troncoso 44 

School disinfection. By Dr. J. T. Ainslee Walker 44 

Campaign against contagious diseases of children. By Dr. Walther Ewald 45 

Management of tuberculosis among school children. By Dr. Arthur T. Cabot. . 46 
Studies in the relation of physical inability and mental deficiency to the body 

social. By Dr. Isabelle T. Smart 47 

Education of immigrants in school. By Dr. William E. Chancellor 48 

Service of medical inspection of schools to the teacher. By Dr. Helen Mac- 

Murchy 49 

Follow-up system in medical inspection. By Dr. Thomas A. Storey 50 

Hygiene of children's teeth. By William H. Potter, D. M. D 51 

Dental hygiene for pupils of public schools. By Dr. S. Adolphus Knopf 52 

Universal system of measurements. By Dr. Leotardo Matus Z 53 

Development of hygiene in educational institutions. By Prof. Dudley A. 

Sargent 53 

Training in personal hygiene in private and public schools. By Prof. John W. 

Ritchie 55 

The public school as a factor to lessen infant mortality. By Dr. Henry L. Coit. . 56 

Physiological age in education. By Dr. C. Ward Crampton 56 

School children of the stock-yards district of Chicago. By Dr. Caroline Hedger. 57 

3 



4 



LETTER OF TEANSMITTAL. 



Department of the Interior, 

Bureau of Education, 

WasUngton, B. C, March 20, 1913. 

Sir: The Fifteenth International Congress on Hygiene and Demog- 
raphy, held in Washington City in the autumn of 1912, was a notable 
event in the history of sanitation and m the discussion of the condi- 
tions of the physical and mental health of the people. The exhibi- 
tion held in connection with the congress was instructive in many 
ways, and contained much of interest to those who are responsible, 
directly or indirectly, for the health of children. 

The first section of the accompanying manuscript contains brief 
and accurate descriptions of some of the most important of the 
exhibits, and comprehensive summaries of their meaning. The 
second section consists of excerpts and summaries containing the 
gist of some of the most important papers read at the congress. I 
believe both will be permanently helpful to teachers, school officers, 
and others interested in the health of children and the sanitation of 
homes, schools, and other places in which they work. I therefore 
recommend the publication of the manuscript as a bulletin of the 
Bureau of Education. 

Respectfully submitted. 

P. P. Claxton, 

Commissioner, 

The Secretary of the Interior. 



IISTTRODUCTIO]:^. 



The exhibition arranged under the direction of Dr. J. W. Sche- 
reschewsky, of the United States Pubhc Health Service, in connec- 
tion with the Fifteenth International Congress on Hygiene and 
Demography held in Washington the latter part of September, 1912, 
was in many regards a remarkable one. To those who had no time 
to spare in making a careful and critical examination of the mate- 
rials and facts presented, as well as to those who strolled through the 
various sections out of mere curiosity, the multiplicity of details was 
doubtless overpowering and perplexing. Those, however, who had 
time to examine carefully and to classify and unify the complex 
materials presented, saw that comparatively few hygienic principles 
were involved. 

When people have pure food, pure water, pure air, and are freed 
from the dust of houses, streets, and manufacturing industries; 
when they have good light and abundant sunshine, sanitary houses, 
barns, and outbuildings; when they are protected from germ- 
carrying agencies, such as flies, mosquitoes, rats, mice, and all such 
pests; w^hen they are protected from people who are carriers of dis- 
ease germs, and taught how to disinfect their homes and communities; 
when they are taught to work and play, eat and sleep, dress and 
bathe, according to the laws of health; when they learn to care for 
their teeth and their eyes, the main problems of hygienic living will 
be solved and human life relieved of its greatest sources of suffering 
and disease. 

The attempt has been made in Part I of this bulletin to describe 
in a brief way some of the suggestive exhibits presented in connec- 
tion with this congress. In no way does it attempt to give an 
adequate idea of the extent and richness of the exhibition as a w^hole, 
but merely to select a few^ exhibits that had more or less direct bear- 
ing on school work and school conditions. 

Part II is made up of abstracts from a few of the papers presented 
at the congress. A volume containing these abstracts was printed by 
the congress in English, and those here reproduced have been taken 
from this volume, with few changes. 

87082°— 13 2 7 



THE FIFTEENTH INTERNATIONAL CONGRESS ON 
HYGIENE AND DEMOGRAPHY- 



PART I. 

SCHOOL BUILDINGS AND SCHOOL SANITATION. 

In connection with the various State health exhibits, many photo- 
graphs of school buildings were exhibited. Most of these represented 
good buildings, constructed in such a way as to aid in conserving the 
health of the children. Some were bad. The most common faults 
consisted in imperfect illumination and inadequate arrangements for 
ventilation, for ridding the air of soot and dust, and for properly 
humidifying the air in the colder climates. 

The problem of inducing architects and schoolmen to locate the 
windows in schoolrooms in the proper places, and to orientate their 
buildings in such a way as to take the best possible advantage of the 
light, is, it seems, an almost hopeless task. By the side of conspicu- 
ous placards lauding the value of sunshine as a disinfectant and of 
good light as a means of conserving the vision of the children were to 
be found school buildings officially commended, but so constructed 
that not a glimpse of sunshine could ever enter some of the classrooms 
for the elementary grades, while the windows were badly placed in 
others. The officers of State boards of health are doing a great service, 
but some of them must learn that the correct planning of a school- 
house is not a matter that can be picked up incidentally. Bread pills 
mixed with a big dose of dogmatic assurance concerning their curative 
properties, discreetly given, might establish an enviable reputation; 
but a poorly constructed schoolhouse demonstrates its defects every 
day to teacher and pupils. It is to be hoped, if State boards of health 
are going to take a large part, directly or indirectly, in the super- 
vision of the construction of school buildings, that they will make a 
thoroughgoing study of all the problems involved. 

The exhibition of knock-down models of rural schoolhouses 
presented by the United States Bureau of Education attracted a good 
deal of attention. This exhibit consisted of 6 models; 3 illustrating 
varieties of one-room buildings, and 1 each of a two, three, and four 
room building. The main purpose of exhibiting these models was to 
set forth a plan by which the bureau will undertake to help the rural 

9 



10 CONGRESS ON HYGIENE AND DEMOGEAPHY. 

districts to better types of school buildings. The chief obstacle which 
has so long blocked the way to progress in securing better types of rural 
schoolhouses is the inability or unwillingness of rural school trustees 
to employ a competent architect to plan their buildings and supervise 
the construction. The so-called architect and builder, or more often 
the ordinary ^^hatchet-and-saw" carpenter of the country, generally 
builds a schoolhouse by copying the plan of some building in a neigh- 
boring district, which in turn has been copied from some other one. 
As a result the progress in constructing better and more beautiful 
buildings is slow and uncertain. It seemed that progress in these 
regards might be accelerated and guided by preparing some carefully 
planned models, in a knock-down form, to be sent directly to district 
trustees or to county superintendents, then set up and copied by the 
carpenters who are called on to build rural schools. The floor plans, 
elevations, and all parts of these models were drawn to scale. 

Three of the models, 2 one-teacher buildings and 1 three-teacher 
building, were constructed by Cooper & Bailey, architects of Boston, 
and 1 one-teacher building, 1 two-teacher building, and 1 four-teacher 
building, were constructed by Mr. W. B. Ittner, the school architect of 
St. Louis. The floor plans were furnished by the Division of School 
Hygiene and Sanitation of the Bureau of Education. Duplicates of 
these models have been prepared by the Bureau of Education and are 
loaned, on request, to those who can use them in building school- 
houses. 

A model and numerous photographs illustrated types of reenforced 
concrete buildings. The model shown was for a concrete building 
suitable for use in a one-teacher district. These concrete buildings 
were designed particularly to meet the most advanced demands of 
State regulations for fire protection. They are literally fireproof. 
A special feature claimed for these buildings is their economy from 
the point of view of construction and repairs. Public School No. 5, 
at Irvington, N. J., has been in use four years, and the statement was 
made that not 1 cent has been spent on it for repairs. By the unit 
system, buildings of factory-made concrete parts are now being put 
up that '^are fireproof, weatherproof, dust proof, soundproof, and 
sanitary," at a cost less than if built of brick or wood. Photographs 
were exhibited of many large school buildings constructed of reen- 
forced concrete at a smaller cost than the estimates submitted for 
the construction of the same in brick and wood. 

Such an exhibit as this is encouraging, for there can be little doubt 
that under many conditions the best and safest material to use in the 
construction of school buildings is reenforced concrete; and when it 
is found that the first cost may be less rather than greater, it will 
cause more school architects to plan for the use of concrete. 



SCHOOL BUILDINGS AND SCHOOL SANITATION. 11 

Glass hlackhoards. — Several glass blackboards were on exhibition. 
It is claimed for these blackboards that they are absolutely non- 
absorbent; that they will not crack, craze, or deteriorate in any way; 
that they are cleaned with a plain rag much more easily than the 
ordinary type of board. Since the idea of glass blackboards will be 
new to many people, the following brief description of how they may 
be made by any careful workman may not be amiss: 

Take a pane of heavy glass, the size desired, lay it flat on a table, 
and with good quality of fine emery dust mixed with a pure thin oil 
scrub it all over so as to cut the surface evenly, completely, but 
lightly. Some skill will be required to do this, but no one ought to 
fail. Some time will be required, and a good deal of labor to pre- 
pare the surface satisfactorily. When this is done roughen the back 
side slightly in the same way and paint it the color desired. 

Set the glass with the painted side against the wall as slate is set, 
leaving the finely and carefully cut surface on the outside for the 
crayon, and the board is ready. It is almost unnecessary to say 
that the color on the back side seems to be a part of the glass itself. 
Such a blackboard can be washed or scrubbed without damage, and 
will absorb neither oil from the hands of the children nor water from 
a sponge. If made well it will cut the chalk readily, will show a 
good mark, may be easily cleaned, and it improves with use. Glass 
blackboards are the most sanitary boards thus far devised, and of 
course will last indefijiitely unless broken by accident. 

Drinking fountains. — ^Various kinds of sanitary drinking cups and 
drinking fountains were on exhibition. In addition to those forms 
generally known and of proved value, there was a new device for 
sterilizing drinking cups. This consisted of four aluminum cups so 
connected with a machine that while one cup is filling, another is 
sterilized by an alcohol flame, so that while the same cups are used 
again and again, there is no need of anyone drinking from a cup that 
has not been thoroughly sterilized. This device, while it offers an 
opportunity for complete sterilization, is neither practicable for 
ordinary school systems nor absolutely safe, for there is nothing to 
prevent one child from drinking a part of the water from a cup and 
then passing it to another. Besides, it is an expensive apparatus, 
and Hkely to be very troublesome for children to manipulate. 

Many varieties of sanitary paper drinking cups were shown, accom- 
panied by convenient devices for holding them. These are both 
sanitary and inexpensive, but nothing of this kind is likely to prove 
satisfactory where large numbers of school children must drink 
quickly and safely. Paper cups are especially valuable in hotels, 
railway trains, and other public places where it is impracticable, for 
one reason or another, to use bubbhng fountains. They will not 



12 CONGKESS ON HYGIENE AND DEMOGEAPHY. 

prove satisfactory for large schools, and especially for the primary 
grades. 

Several types of bubbling fountains in connection with ordinary 
water jars, or coolers, have been manufactured for use in rural schools, 
where waterworks systems are not found, or even where a pressure 
tank is not used. Two kinds of such fountains were on exhibition. 
These will prove very helpful to country and village schools, and 
deserve the attention of all who are seeking to avoid the menace of 
dirty buckets and common drinking cups. 

There were two exhibits of paper towels for use in schools and in 
pubhc places generally. The use of these towels will greatly sim- 
plify the problems of cleanhness and prevent the possibility of the 
spread of eye or skin diseases. They are put up on rollers and in 
pads, so that they may be used economically and with perfect clean- 
liness. Where carefully supervised, and where the children are 
taught to use them properly, they have proved acceptable and have 
brought great relief from the trouble and expense of individual 
towels. The use of the common roller towel in schools or public 
places should be forbidden by law everywhere. 

Among other materials, devices, etc., included in the exhibition, 
which have a bearing on school sanitation, may be mentioned a new 
material for flooring, made by a New York concern. In appearance 
it resembles artificial stone, but it is of light weight, comparatively 
noiseless, nonabsorbent, and, it is claimed, is not a rapid heat absorber. 
It is easily cleaned, can be made in several colors, and is thoroughly 
fireproof. This material deserves the attention of school architects 
and schoolmen, with especial reference to its use in halls and domes- 
tic-science rooms. 

The Forsyth Dental Infirmary for Children. — One of the most sig- 
nificant facts connected with the movement for conserving the teeth 
of children is the founding and endowment at Boston of the Forsyth 
Dental Infirmary for Children. A beautiful model of the building 
now under construction at 140 Fenway was exhibited. This insti- 
tution was founded by John Hamilton Forsyth and Thomas Alex- 
ander Forsyth in memory of their brothers, James Bennett and 
George Henry Forsyth. It was incorporated in 1910, and has an 
endowment of $2,000,000. 

It will offer opportunity to all deserving children under 16 years of age to obtain 
freely expert advice and care for their mouths. ■^ ■**■ * Its functions will include 
not only care of the teeth, but also related conditions, including defective palates, 
adenoids, etc. Much of the work it will be called on to do in its early years will deal 
with the cure of defects already established. It is expected that, as its scope enlarges, 
it will have to do in great part with the prevention of defects by oral prophylaxis. 

Apart from the actual work on mouths, it is expected to furnish valuable practical 
teaching in oral hygiene. Just as the sanatoria for the cure of tuberculosis have served 



SCHOOL BUILDINGS AND SCHOOL SANITATION. 13 

as centers for the dissemination of wisdom concerning personal hygiene by the exam- 
ple and teaching of their patients, so it is expected that this institution will promote 
public education in not only oral, but also general hygiene. 

Provision has been made for research. A research fellowship has been established 
and is now held by a man selected for his fitness. The laboratory will be so equipped 
as to offer opportunity under expert supervision for special work in research by men 
who desire to do this work. 

The museum of the institution, it is hoped, will be a depository for materials of every 
kind which can be used for the teaching of oral hygiene. The lecture room will be 
used for the education of the public in dental matters. 

The building is to be a model in all those things which will insure 
hygienic conditions for operators, research workers, and the children. 

Dental clinic. — ^A fully equipped dental clinic was a feature of the 
exhibit, and dentists were in attendance, busily examining the 
mouths of children. The object was to show the method of making 
an examination of the teeth of children in the public schools, and of 
keeping a record of the same. The examinations were made in an 
aseptic manner, the only instruments being a bit of wood of suitable 
size and shape, which was used but once, and a mouth mirror which 
was carefully sterilized by the assistant after each examination; 
the hands of the operator never touched the child. It was designed 
to call attention to the importance of the examination of the mouths 
of school children, as it is recognized at the present time that a large 
number of the general infections result from neglected mouth condi- 
tions. An operative cUnic in connection with the examining clinic 
was conducted simply as a demonstration of the methods of working 
for school children from charts after the examinations had been made. 
It may be interesting to state that the operators obtained their mate- 
rial — children — through the cooperation of the Associated Charities, 
and they could have had an almost unUmited amount of material, 
the conditions were found to be so distressing. 

Charts were conspicuously displayed bearing inscriptions such as 
these : 

The temporary set of teeth is equally as important as the permanent set. Child- 
hood is the growing period, when the body should receive the maximum of nutrition. 
Food can not nourish unless properly masticated and prepared for absorption. 

The child who has defective teeth is more easily a prey to all infectious diseases. 

Spiral fire escape. — An interesting exhibit was a model of a spiral 
fire escape in which, to the delectation of visitors, china dolls were 
sent safely down from imaginary tall buildings. The essentials of 
this fire escape consist of a large steel cylinder with a spiral slide 
securely fastened to the sides and to the central axis. From each 
floor of the building to be protected there is a metal runway from 
the building to an opening into the spiral. When, therefore, the fire 
escape is to be used, the children march out and jump into the spiral, 
feet foremost, and gravity does the rest. The danger from clogging 



14 CONGRESS ON HYGIENE AND DEMOGRAPHY. 

the spiral is negligible, and the danger from landing below is very 
slight. It is to be hoped, however, that fire escapes jper se will soon 
be useless, for there is now no excuse for the construction of non- 
fireproof buildings for school purposes, especially in cities. 

The dust 'problem. — Most people know in a general way that it is 
unwholesome to breathe dust, whether it is found in the air in build- 
ings or outside, for dust particles are not only deleterious in them- 
selves by irritating and loading the mucous membranes of the air 
passages, but they carry with them great numbers of bacteria, path- 
ogenic and nonpathogenic. The problem, then, of clean air is closely 
linked to the problem of ventilation, as well as to that of general 
sanitation. 

One of the hard probleriis in school sanitation in cities has been 
that of ridding the air of dust and soot before it is introduced into 
the schoolroom. It will not be such a difficult problem to keep the 
air of school buildings free from dust if the janitor is able to take 
from the floor most of the dust carried in by the children before it is 
lifted into the air. 

There was demonstrated at the exhibition a type of oil brush that 
may be used to sweep all kinds of floors. The brush is fitted with a 
reservoir containing plain kerosene oil. When the brush is properly 
used the light row of center tufts on the brush is kept just moist 
enough with the kerosene to dampen the dust and roll it together, 
but not to oil the floor. The brushes are made in numerous styles 
and sizes. They are already in practical use in many schools in the 
West and in some of the public buildings at Washington. Such a 
brush deserves careful consideration, especially by country and vil- 
lage school officials, where muddy shoes are so common and where 
dust is consequently a serious problem within the room. 

Several varieties of sweeping compounds designed to gather and 
hold the dust when fioors are swept were exhibited. These are on 
the market and need no special mention here. A good quality of 
sawdust moistened with paraffin oil is a good substitute for these 
compounds, though some of the preparations on the market have 
advantages in holding the dust, and they are not prohibitively 
expensive. Experiments made with such a compound by Dr. Alvin 
Davison, professor of biology at Lafayette College, proves its use in 
gathering up germs. He says, in a pamphlet on ''Dust as a Carrier 
of Disease in the Schoolroom," that "in sweeping an ordinary school- 
room the preparation used was able to catch and hold fast more than 
a hundred million germs." 

For fioors and walls there were mops, cloths, and brushes impreg- 
nated with a chemical which causes them to catch and hold the dust. 
These mops, cloths, and brushes are washable after use, and when 
thus cleaned can be used repeatedly. Many of them are particularly 



SCHOOL BUILDINGS AND SCHOOL SANITATION. 15 

useful for schools. In this connection may be mentioned the janitor- 
size handle duster for cleaning walls. 

All of these are much more efficient than damp cloths or any ordi- 
nary dust cloths. They, of course, are as applicable to home use as 
to school use. It will be worth the while of school men to examine 
these brushes and test them by the actual and regular work set for 
their janitors. 

A very instructive exhibit by the Massachusetts State Board of 
Health showed specimens of dust taken from machines operated by 
workmen and gave a vivid suggestion of how the lungs of workmen 
are exposed to all sorts of irritation and unwholesome conditions. 
This exhibit showed 20 varieties of dangerous dusts. Among these 
were noted: Dust from raw cotton, this dust being carried from the 
field from the time it is picked until it reaches the mill; jute fiber 
dust, broom-corn fiber dust, rattan dust, celluloid dust, dust from 
fur, and from various stages in the manufacture of leather and many 
other commodities. 

Photographs were exhibited showing many ingenious devices to 
prevent the entrance of dust with the inspired breath. Not only 
must the dust be drawn from the rooms by exhaust fans to make 
some manufacturing industries safe, but the eyes of the workmen 
must be protected by strong glasses, and they must breathe through 
various forms of protecting absorbents to avoid the dangers of nox- 
ious fumes and deleterious gases. Progress in controlling '^industrial 
dust" was shown in many exhibits, and this augurs well for better 
care of the workers of the future. 

Gleaning and Jiumidifying the air. — A complete air- washing and 
humidifying device was exhibited, the essentials of which are as 
follows : 

The air to be used in the school building or manufacturing estab- 
lishment is drawn through a chamber in which a battery of spraying 
nozzles are situated. These sprays are so set, so constructed, and 
operated that the water is broken into a fme mist and driven directly 
into the teeth of the incoming current of air. As a result, the dust 
particles in the air are laden with moisture and the space between 
the gaseous atoms composing the air, filled with moisture; or, in com- 
mon parlance, the air is completely saturated. The air then strikes a 
system of zigzag eliminator plates set vertically, over which sheets 
of water flow. The moisture-laden dust is caught by these streams 
of water and carried into a settling tank below, or directly to a waste 
water pipe. The saturated, washed air is then heated, if heat is 
required, or in warm weather driven directly into the rooms. The 
controlhng devices for regulating the temperature of the water in 
the spraying nozzles, and the temperature of the air driven into the 
rooms, are essential elements in regulating the percentage of satu- 
87082°— 13 3 



16 CONGRESS ON HYGIENE AND DEMOGEAPHY. 

ration. Excellent results may be expected where such machines are 
properly installed and operated. One practical difl&culty is sug- 
gested, however, and that is that a machine as carefully planned and 
built as this requires skill and brains on the part of the operator in 
order to obtain the best results. The ordinary school janitor is not 
competent to handle it and keep it working as it should and would 
with more inteUigent supervision. This difficulty, however, is due to 
the fact tlmt our general janitor service is at fault. The janitor of a 
modern up-to-date school must be trained to work with modern 
machinery, if school sanitation is to keep pace with the demands of 
health conditions. Business concerns put such machinery under the 
control of trained engineers. 

If school buildings in cities could be removed from the smoke and 
dust zone and placed in large grounds, there would be less need of 
washing the air. But the need for humidifying the air in cold cli- 
mates is generally recognized by all students of school hygiene. 

Schoolrooms where dry air is troublesome will be able to relieve 
this dryness somewhat by the use of a device in the exhibition con- 
sisting of a wheel-shaped affair made with crossed porous tubes 
attached to an ordinary electric fan. The tubes as exhibited were 
fed with a fragrant compound of oil of pine needles, oil of sweet birch, 
oil of sandalwood, and eucalyptol. This gave a dehghtfully refresh- 
ing odor and added some moisture to the air. They could be made 
larger and set in a hot-air chamber and fed with water. This device 
has been in use in Germany for a number of years. It is not claimed 
that the apparatus will properly humidify the air; it will, however, 
alleviate to some degree the conditions in a schoolroom where the 
air is dry and malodorous. 

Sanitary toilets. — It is almost futile to have clean schoolrooms, 
sanitary drinking fountains, and the other modern means of pre- 
serving the health of the child in school unless equally great atten- 
tion is paid to the sanitation of the school toilet, whether in the 
building or out of doors. In the first place the lesson of contamina- 
tion needs to be continually driven home. Early life is intricately 
bound up with it, and unless we teach the children of to-day what 
is wrong with most of our sanitary arrangements, and how they can 
be made right, the parents of to-morrow wiU be as much at fault as 
we are to-day. 

The accompanying illustration of a model exhibited by the United 
States PubUc Health Service shows as simply as is possible what hap- 
pens in too many instances on school grounds or on the farm. The 
scene is a typical attractive farmhouse, but the modeler for our pur- 
pose has cut away the earth which hides from us the unpleasant 
underside of the picture. The well is bored deep — there can be no 
complaint on that score. The arrangement of the strata, however, 



BUREAU OF EDUCATION 



BULLETIN, 1913, NO. 18 




MODEL SHOWING WELL POLLUTION. 



SCHOOL BUILDINGS AND SCHOOL SANITATION. 17 

tells the story of contamination. From the privy the waste oozes 
through the porous layer into the fissured rock. Through these fis- 
sures it goes until it strikes the layer of impermeable clay between the 
rock and water-bearing strata. Not being able to get through the 
clay, it follows the slope and soon reaches the well bore. On the 
other side of the well the waste from the stable penetrates similarly 
the porous layer and works down through the fissures in the rock until 
it too finds a resting place in the already contaminated well. 

The problem of the farm and school privy, therefore, is one of ar- 
resting the waste before it can get into the ground and contaminate 
the soil and the water supply. How much can be done to remedy 
the usual bad condition by making certain changes in the sanitary 
arrangements of the old-fashioned closet is seldom reahzed. 

The United States Pubhc Health Service showed a number of mod- 
els of sanitary privies that are a striking contrast to the typical school 
and farm building. These privies are, first of all, properly ventilated, 
in forcible contrast to the prevailing type, and the openings to 
provide ventilation are carefully screened. The waste matter, 
instead of entering the ground on its journey to some well or spring 
in the vicinity, is caught in a sanitary container, where it can be 
easily treated to remove the great mass of objectionable matter. 

The L. R. S. privy was shown, the principle of which is as follows: 
The solid matter is liquefied, and the liquid that issues from the con- 
tainer is of small volume, very much less dangerous to health, and can 
be easily sterilized if desired. The construction of this privy is not 
expensive, and it can be built to serve any country school. An 
account of sanitary privies, with illustrations, may be found in Bul- 
letin No. 37, 1910, of the United States PubHc Health Service, and 
may be had from the Superintendent of Documents, Government 
Printing Office, Washington, D. C, for 5 cents. 

School desks. — The proper adjustment of school desks is still a 
problem, as the ideal hygienic school desk has yet to be made. In 
addition to a number of the usual styles of school desks, a special desk 
for crippled or abnormal children was displayed. The chair accom- 
pan5ring this desk has an adjustable sloping back, and the desk 
itself is adjustable to different heights. A special feature of the 
adjustable chair seat for crippled children is the hinged section, which 
remains up or down according to the needs of the child; that is to 
say, if the child has a stiff leg, the seat may be adjusted to its support 
without discomfort to the child. Several examples of movable seats 
were shown, and a special plea was made in connection with this 
exhibit for this type of seat. Attention was called to the danger of 
forcing pupils to sit at a fixed desk of specific size. The literature 



18 CONGKESS ON HYGIENE AND DEMOGRAPHY. 

distributed by the exhibitors quotes Dr. Montessori to the following 
effect: 

The principal modification in the matter of school furnishings is the abolition of 
desks and benches or stationary chairs. 

I know the first objection which will present itself to the minds of persons accustomed 
to the old-time methods of discipline — the children in these schools moving about, will 
overturn the little tables and chairs, producing noise and disorder — but this is a preju- 
dice which has long existed in the minds of those dealing with little children, and for 
which there is no real foundation. 

Swaddling clothes have for many centuries been considered necessary to the new- 
born babe, walking chairs to the child who is learning to walk. So in the school we 
still believe it necessary to have heavy desks and chairs fastened to the floor. All 
these things are based upon the idea that the child should grow in immobility, and 
upon the strange prejudice that, in order to execute any educational movement, we 
must maintain a special position of the body. 



HYGIENE AND TUBERCULOSIS. 

The health authorities of New York City are undertaking an almost 
superhuman task in attempting to check the ravages of pulmonary 
tuberculosis. Without going into the details of the plan presented 
as a part of their health exhibit, excerpts from one of the Monograph 
Series (No. I, February, 1912), published by the department of health, 
and reprinted in the appendix to this paper (p. 40), will give some 
idea of the extent of the educational work of the department in teach- 
ing the people how to prevent infection and how to undertake to 
effect a cure when infected. These directions are worth the careful 
consideration of teachers, health authorities, and aU others who are 
striving to conquer the ''Great White Plague." 

The value of pure air. — In all the exhibits relating to the newer and 
better school buildings of the country, a noticeable improvement was 
evident in methods of construction and equipment with reference to 
ventilation. All large city school buildings recently constructed are 
equipped with the plenum system of ventilation. This means that 
fresh air is forced into these buildings by a fan system so installed 
and so regulated as to furnish to each child a sufficient supply of pure 
air. Because many plenum and other systems of ventilation have 
been erroneously installed and poorly operated in modern school 
buildings in the past few years, some school men have hastily con- 
cluded that we are proceeding on the wrong method, and have 
condemned without due consideration. 

The chief cause for this complaint is the attempt to furnish suffi- 
cient air with a fan or fans too small to do the work expected of 
them. It is false economy to install fans requiring a maximum speed 
to furnish the quantity of air required. The ducts to carry the air 



HYGIENE AND TUBERCULOSIS. 19 

to and from the schoolrooms should be ample to insure sufficient 
movement of the air to keep all parts of each room well ventilated. 
It was interesting to note in the large exhibits of up-to-date manu- 
facturing establishments that inadequacy in these respects was gen- 
erally avoided, for it has been learned that economy in operation 
is always conserved by the use of machinery whose maximum power 
is always far beyond the ordinary requirements. Where many people 
work, for many consecutive hours during cold weather, in tight, well- 
constructed buildings, no other system of ventilation has been devised 
which gives as good results as the plenum system, aided by an exhaust 
fan or some other method of artificially creating a draft in the outlet 
ducts. In practically all of the manufacturing industries where pure 
air for the workers means better work and a larger output, the ventila- 
tion furnished is more nearly adequate to the needs of good health 
than in our best schools. False economy in factories shows in dollars 
and cents; in schools the direct economic bearing of bad air is not 
so readily seen, but the bills are finally paid in health and life. 

Open-air schools and open-air sleeping rooms. — The movement for 
open-air schools is directly traceable to the recuperative effect of 
outdoor air on sick children and adults. It was to be expected, 
therefore, that the exhibits of hospitals and sanitariums, especially 
those designed for the care of tuberculous patients, would show the 
greatest progress in this direction, and that schools for defective 
and anemic children should show more provision for outdoor class- 
rooms than schools for normal and healthy children. But the fact 
that the effect of preaching the gospel of fresh air and of the out-of- 
doors was shown in all such buildings is a very hopeful sign. More- 
over, the movement is spreading to the homes, the shops, and 
especially to those industrial and financial organizations which count 
the health and welfare of their workmen as a financial asset. It 
marked a new era in educational hygiene when insurance companies 
found that it would be profitable for them to teach their policy 
holders not only to keep themselves well and thus prolong their lives,but 
also to keep their families well and happy, and thus indirectly to make 
the payment of premiums more regular and certain. In one of the 
beautifully printed booklets exhibited by a manufacturing establish- 
ment, photographic illustrations were shown of methods of construct- 
ing outdoor sleeping rooms, and were accompanied by such legends as 
these : 

Plenty of good fresh air will make the fires of life and health burn brighter; there- 
fore do not hibernate — ventilate. 

If you can't work outdoors, sleep outdoors. 

The only night air that is injurious is last night's. 



20 CONGRESS ON HYGIENE AND DEMOGRAPHY. 

A life insurance company showed a model of its sanitarium where 
consumptives are treated. In connection with this model placards 
were exhibited saying : 

When a consumptive can not be sent to a sanitarium, arrangements for taking the 
cure at home should be made as soon as the disease is discovered. 

Sleep with your windows open. Do not be afraid of night air. Do not be afraid 
of cold air. 

Do not live in a room where there is no fresh air. Do not work in a room where 
there is no fresh air. Do not sleep in a room where there is no fresh air. 

Consumption is a preventable disease; it is a curable disease. 

Sunlight and fresh air kill tuberculosis germs. 

This sanitarium was constructed for the cure of clerks and those 
who have developed tuberculosis while in the service of the company. 
There are 415 acres included in the sanitarium grounds. The buildings 
are fireproof throughout, and are designed to accommodate 200 
patients. It is planned to have also an extensive garden in connection 
with it, where fresh farm products can be utilized for food, and 
where helpful outdoor work for the patients may be obtained. It is 
needless to say that in the buildings open-air sleeping rooms and 
opportunities for open-air exercise and recreation have received 
paramount attention. 

The same company, in connection with its exhibits, distributed an 
illustrated pamphlet with the title, Directions for living and sleeping in 
the open air. On the bottom of the outside cover, it was stated that 
this was 'issued for the use of policy holders." This pamphlet was 
prepared for the company by Dr. Thomas S. Carrington, assistant 
secretary of the National Association for the Study and Prevention of 
Tuberculosis. It is an educational document, pure and simple^ 
written by an eminent specialist and illustrated in such a way as to 
help anyone in the construction and equipment of open-air sleeping 
rooms. It is barely possible that this company had in mind to do a 
general social service by the publication of this pamphlet; but it is 
practically certain that it would not have been printed had they not 
realized that it would serve to teach their policy holders and all 
others who read it that sleeping in the open air will insure better 
health and longer lives and in the end prove a good investment for 
all concerned. Such educational work pays, and business corpora- 
tions are not slow to take advantage of the commercial aspects of 
good health. This kind of " enlightened selfishness " is a sort to which 
no worker can object, for it helps both capital and labor and harms 
neither. It approximates a phase of practical ethics which suggests 
a basis for a larger common understanding. 

This same company has established a visiting nurse service for its 
sick industrial policy holders. V^ile of course such service is 



HYGIENE AND TUBERCULOSIS. 21 

expected to aid directly in helping to save the lives of these policy 
holders, the real aim and purpose of this service is educational. The 
significant remark made about the value of the nurse in the printed 
matter is this: 

It is sufficient for the purpose of the company to realize that the work of a nurse 
is part of an educational propaganda, and that in the long run her services must 
redound to the general benefit and welfare of the policy holders. There can be little 
doubt, however, that in time strong evidence will be forthcoming of a considerable 
improvement in the mortality of policy holders. * * * As a matter of interest, 
it may be noted that at the end of June, 1912, the nursing service experiment was 
being conducted in approximately 1,104 cities and towns in the United States and 
Canada, and for the year 1912 it is conservatively estimated that a total of 1,000,000 
visits will be made to policy holders of the company at a total cost of $500,000. 

It would be a dull mind indeed which could not see that such 
activity as this, duplicated in its general purposes and work by 
numerous other business concerns, represents a new phase of edu- 
cational service to the whole nation. It matters not who does the 
teaching so long as it is done effectively and purposefully. 

In the exhibit of Cleveland, Ohio, showing the ''Cooley Farms," 
there was a plaster cast model of a 500-acre farm for a tuberculosis 
sanitarium to cost $500,000, as well as of a colony farm of 500 acres 
for an infirmary or almshouse. In the exhibit a placard stated that 
2,000 acres of land furnished opportunity for 8,000 prisoners to work 
in the open fields, without lock or bar. ''The open sky is better than 
the dark cell." These facts remind us again that we are giving rela- 
tively more attention to those who have gone wrong than we are 
giving to to those who have not yet gone wrong, and will not go 
wrong if they have the opportunity of decent treatment and decent 
development. It seems unfortunate 'that our minds, even in exhi- 
bitions on hygiene, have been concentrated on cure instead of on 
prevention. Still, the fact that authorities are realizing that the open 
air and the sky and employment will reconstruct body and soul of 
both the sick and the criminal has for us the lesson so often taught 
of late, that fresh air, sunshine, and congenial wholesome employ- 
ment offer the biggest developmental opportunity any man needs. 

In order to see how the cities in the northeastern section of the 
country are undertaking to meet the difl&cult health situations brought 
about by the great influx of population from foreign countries and 
congestion of the population, one only needed to read a card posted 
by the Rochester (N. Y.) PubHc Health Association, showing the age, 
sex, nationality, and diagnosis of the children who were gathered in 
their open-air schools which were started July 4, 1912. The chart 
here follows. - - 



22 



co:n'gress on hygiene and demography. 

Open-air school, Rochester, N. Y. 



Age. 


Sex. 


Nationality. 


Diagnosis. 


5 


Female. 


ItaUan. 


Tuberculosis, 


9 


Do. 


German. 


Do, 


12 


Male. 


Do. 


Do. 


10 


Female. 


Italian. 


Do. 


9 


Do. 


Hebrew. 


Do. 


12 


Do. 


Italian. 


Do, 


9 


Male. 


Do. 


Do. 


6 


Do. 


American. 


Do. 


16 


Do. 


Irish. 


Do. 


8 


Do. 


American. 


Do. 


16 


Do. 


Italian. 


Do. 


6 


Female. 


Hebrew. 


Do. 


13 


Do. 


Italian. 


Do. 


9 


Do. 


Hebrew. 


Do. 


7 


Do. 


Do. 


Do. 


8 


Do. 


American. 


Do. 


9 


Male. 


Irish. 


Do. 


6 


Female. 


English. 
Hebrew. 


Do. 


11 


Do. 


Do. 


12 


Male. 


American, 


Do. 


10 


Female. 


(Jerman. 


Do. 


9 


Do. 


Hebrew. 


Do. 


5 


Do. 


Irish. 


Do. 


8 


Do. 


Italian. 


Do. 


12 


Do. 


Do. 


Do. 


8 


Male. 


Hebrew. 


Do, 


8 


Do. 


Irish. 


Do. 



Boy Scouts. — The exhibit of the Boy Scouts consisted chiefly of 
photographs of boys on the trail, in camp, fishing, signahng, drilling, 
and the general opportunities they have in their '^ hikes'^ for coming 
in contact with nature and trjring to make themselves comfortable 
and happy under various conditions. Other photographs show them 
exercising, swimming, boating, and at lectures on ''first aid;" study- 
ing trees, and in general trying to adapt themselves to nature and 
make the most of situations away from the hurry of the crowd. The 
great expansion of this movement in the last few years has been one 
of the wonders of organization. Whether or not this will degen- 
erate into a sort of semipreparation for war, one can not say, but at 
present it is doing enormous good in taking boys out of the cities and 
giving them a breath of fresh air, and bringing them in contact with 
nature in its various moods and conditions. Without such an organi- 
zation as this, many boys would never get the opportunity thus given 
for journeys into the country to test their own strength and develop 
their own powess. 

Tom Sawyer was a philosopher, and knew how to get other boys to 
do his work if only in some way he could get those boys to imagine 
that it was play and not work. 

The Kansas Boy Scouts have organized an antifly campaign under 
the guise of uniform and mihtary tactics and the other little folderol 
of organization. Wise heads have directed their energy and strength 
to cleaning up back yards, dirty streets, and setting an example before 
older people of cleanliness and ail that is associated with it. 



INDUSTRIAL HYGIENE. 23 

INDUSTRIAL HYGIENE. 

Without doubt one of the most encouraging signs of progress in 
hygienic Hving was that shown by the rapid development of methods 
of protecting workmen from what are known as occupational dis- 
eases. Knowledge of the laws of health and of the economic value 
of health is slowly but surely revolutionizing the attitude of manu- 
facturers toward their employees. Due to the fact that good health 
is now being valued as an economical asset, not only by the workman 
but also by the employer of labor, it is no longer a mere matter of 
humanitarian sympathy to furnish fresh, clean air, good light, and 
safe environment to workmen; it also pays. Perhaps no phase of 
hygienic science received, on the whole, so much attention in the 
exhibition as this. At first glance it may seem to indicate low ethical 
standards of our people to find that better health conditions are often 
contingent on mere economic considerations. But on closer analysis, 
one is inclined to believe that this is in the direction of a higher form 
of ethics. The fundamental principle everywhere exhibited in society, 
which demands returns comparable to the science and skill involved 
in the labor, is finding a new exemplification in the economic value 
of good health and congenial environment. 

It is one-sided ethics to give without the expectation of some 
form of return. True, the highest form of return in many under- 
takings is not measureable by economic standards; but business life 
must be so measured, else it could not be maintained or developed. 
Where the demands of the workman for wholesome conditions are 
seen to be not only consistent with his own welfare and happiness 
but likewise compatible with the economic success of employers, then 
a higher and safer plane has been reached and the dangers of dis- 
satisfaction and misunderstandings lessened. 

Laundry workers are now relieved from excessive steam and humid- 
ity in the workrooms. This is done by the plenum and exhaust- 
fan system, which not only furnishes fresh air but removes the steam 
and undue humidity from the air. The exhibition on the cotton 
industry showed wonderful progress in the way of removing lint from 
the air and in humidifying and ventilating. In the best woolen 
mills, where workers are exposed to infection and the inhalation of 
shreds of fiber, the lighting and ventilation and cleanliness are 
being looked after with great care. There was also a great mass of 
photographs showing factories with ideal sanitary conditions, and 
some showing bad conditions and ineffective apparatus. 

One of the striking features of modern factory life is the rapid 

development of life-saving through better ventilation. In all 

phases of manufacturing where dust and bits of metal or glass are 

likely to be scattered through the air, and thereby injure the health 

87082°— 13 4 



24 CONGRESS ON HYGIENE AND DEMOGEAPHY. 

of the workmen, the fan system of furnishmg fresh air and exhausting 
the dust is bringing much relief. This method was shown in the 
manufacture of cut glass and photo-engraving by fan systems for 
exhausting the fumes and other deleterious substances released by 
chemical or other processes. The composing rooms of newspapers, 
whether in the basement or in the attic, are now ventilated and 
purified, not only as a means of saving the lives of the workmen, 
but from an economical point of view ; it has been found that work- 
men will do better work and more work under these conditions than 
under insanitary conditions of the air. Even in those manufacturing 
establishments where comparatively little dust is released, but 
where many people are at work, the air is purified in winter by 
means of forced ventilation, and in summer large windows furnish 
abundant fresh air. 

The industrial diseases reported to the State department of labor 
for the first nine months of 1911, under New York reporting laws, 
show a total of 146 cases, lead poison leading all others, with caisson 
disease second. 

The best department stores throughout the country are seriously 
engaged in furnishing to their salesmen and women good air, rest 
rooms, sanitary toilets, ventilated locker rooms, sanitary drinking 
fountains, emergency hospitals for women; and instruments have 
been designed for analyzing air in various workshops and mercantile 
establishments. Rogers's apparatus for determining carbonic acid 
(CO2) was on exhibition in connection with the display of mercantile 
and manufacturing establishments. 

A large and well-known manufacturing company exhibited its care 
for the health of its employees by illustrated lectures on digestion, per- 
sonal hygiene, circulation, respiration, effects of narcotics, housing con- 
ditions, tuberculosis, venereal diseases, and campaigns against the fly. 
It attempts to improve its shop conditions by special cleanliness, 
systematic disinfection, and perfect ventilation. It furnishes baths 
for all its employees, and maintains a sanitary barber shop. Clean 
aprons and sleevelets are provided, also individual towels, combs, 
and brushes, the latter being sterilized daily. It employs a factory 
physician who makes a physical examination of all employees; an 
oculist who looks after the eyes of the workmen; trained nurses to 
care for the sick and advise those who are in need of their services. 
It provides an emergency hospital and ambulances. It has organized 
relief associations, and changes the occupations of the workmen in 
order to help them maintain their health. 

One cabinet of this exhibit was devoted to the importance of air 
and light. Prominent among the placards in this cabinet were the 
following: 



INDUSTRIAL HYGIENE. 25 

Don't sleep where there is no fresh air; don't work where there is no fresh 
air; don't live where there is no fresh air. 

The trouble is that people do not allow enough fresh air and enough sunlight 
into their rooms. 

Consumption causes more deaths than any other disease. Nearly one-third 
of all the people that die between 20 and 45 years of age die of consumption. 

Consumption is caused by the dust from dry spit. Don't spit on stairs. 
Don't spit on sidewalks. 

The germs of tuberculosis enter the living body through the lungs and 
mouth by breathing; also by infected food. 

The only consumptive to be afraid of is the careless consumptive. 
He coughs and spits anywhere and everywhere; he is a danger to the 
neighborhood. 

Alcoholic drinks are particularly bad for persons suffering from consump- 
tion. They don't cure, they kill. 

A large number of beautifully colored photographs of interiors of 
workrooms and machine shops, showing abundance of good light, 
were exhibited. The grounds about the buildings are kept clean and 
are beautified with vines and flowers. One placard stated that four- 
fifths of the buildings are glass, thus giving ample opportunity for 
sunshine and fresh air. Air, light, water, food, and exercise are men- 
tioned as the essentials of hygiene in connection with its industry. 
Fresh air is furnished by means of forced ventilation, taking the air 
from above the buildings and forcing it into the rooms by means of 
fans. Foul air is also drawn out through the wall by ventilators and 
exhaust fans. All air in the buildings is changed every 15 minutes. 
The buildings are removed from other buildings, so that there is air 
space between them all, and to prevent contamination of the air 
160 acires of park land separate the buildings from other structures. 
Light is furnished through windows aggregating four-fifths of the 
wall space of all the buildings. The buildings are painted a soft 
color, so that the glare will not weary the eyes. 

Sanitary drinking cups, sanitary drinking fountains, and distilled 
and aerated water are used, and no ice comes in contact with the 
drinking water. In the food department there are sanitary kitchens, 
a cold-storage plant, and specially trained waiters who are required 
to take every precaution to prevent contamination of foods. To 
furnish proper exercise there are gymnasiums, a country club, horse 
riding, baseball diamond, tennis courts, golf clubs, a cross-country 
walking club, and ample playgrounds. For women, morning and 
afternoon recesses. 

Truly, such a program as this reads as if it were made for a special 
school of sanitary living, and in reality it is such. But primarily 
it was developed as a business proposition. The company has 
found that good health among its workers is one of its most valuable 



26 CONGKESS ON HYGIENE AND DEMOGKAPHY. 

assets, and that every precaution it can take to guard them from 
accident or disease is money well spent. It has also discovered that 
recreation and fun constitute a vital part of a man's needs, and that 
it pays for a manufacturer to make provision for this phase of the 
life of workers. 



NOURISHMENT OF CHILDREN. 

American custom has not yet sanctioned many health measures by 
the city and State that more paternal Governments have long put 
into effect. Most suggestions for direct supervision of the nourish- 
ment of school children in this country are generally frowned upon by 
educators and the public alike. At the same time, it is safe to say 
that American teachers have not begun to do as much in an advisory 
way toward solving the problem of malnutrition as they can do. 
Some of the points upon which the teacher can give very definite 
instruction were shown interestingly in the exhibit. 

First of all, in a great number of the exhibits, emphasis was placed 
on the necessity for proper infant feeding. After the child becomes 
of school age, the teacher becomes in a sense the most important 
supervisor of the health of the children. The ill effects of insufficient 
or improper nourishment, which may not always show when the 
child is at play in the house or out of doors, are revealed directly to 
the teacher during the school session. Inattention, apparent dull- 
ness, and all the various irregularities that come from lack of nutri- 
tion reveal themselves to the practiced teacher. 

The importance of the cleanliness of purchased products was also 
strikingly emphasized. If a child can be taught to understand the 
risk of unclean markets, he will impart this information to the parents. 
This is particularly important in the case of large cities having an 
alien population. As an example of what may be done in teaching 
the significance of cleanliness in the sale of groceries and similar goods, 
an exhibit by the market committee of the Women's Municipal League 
of Boston may be taken. On one side of an aisle was a model of a 
small city grocery and vegetable stand of the undesirable sort. The 
potatoes, cabbages, turnips, and onions all mingled together in dirty 
boxes, with a not-too-clean fox terrier standing guard over them; a 
rough-board table with a pile of nondescript bread, cakes, crackers^ 
and rolls, flanked by more vegetables, and some canned goods in 
decidedly unattractive cans, with a cat, that notorious carrier of 
germs, seated in the midst. Flies were omnipresent, and the pro- 
prietor's coat was ready to be thrown over this food supply in case 
of rain. 

On the other side was a clean market, amply protected from dust 
and flies. The bread was wrapped in sealed wrappers ; the cakes and 



NOURISHMENT OF CHILDREN. 27 

rolls were under glass covers; the groceries were all kept separate 
and distinct in glass compartments; and the whole environment 
clean and inviting, with little added expense. 

The whole purpose of this exhibit was to show those who ought to 
know the importance of the scrupulous care of food products for 
household consumption. The successful accomplishment of this 
represents one of the first and most needed steps in providing proper 
food for children. 

The Women's Municipal League of Boston also exhibited a model 
of a play grocery shop of the better type, which is carried from one 
social settlement house to another. The children play in it, and 
through it are taught the value of orderliness and cleanliness. This 
shop as shown was inexpensive to equip, and for the few dollars 
outlay necessary almost any community could demonstrate to its 
children, and through them teach the parents and dealers themselves, 
the ease with which cleanliness can be obtained. 

In this same connection the New York association for improving 
the condition of the poor demonstrated in an interesting fashion 
what can be done in providing wholesome and economical meals for 
school children. Six prepared meals were shown in models. The 
first three represented what the school child was fed by the parents 
before they had instruction in food values. The second three showed 
the meals provided by the parents after they knew what to give their 
children. If every teacher could see these two varieties and could 
impress in this objective way the children or their parents with the 
importance of the difference between the two, there would be fewer 
ill-nourished and underfed school children to dawdle away their time 
because of insufficient energy at command. 

The following are the menus: 
Before instruction. 

Breakfast: Coffee with milk and sugar, cruller, and sugared bun. 
Lunch: Coffee with milk and sugar, bread and butter, cruller, and slice of ham. 
Dinner: Coffee with milk and sugar, bread and butter, bologna, pickle, piece of 
pie, and dish of sliced bananas. 

After instruction. 

Breakfast: Chocolate, bowl of cereal, pitcher of milk, whole-wheat bread, dish of 

prunes. 
Lunch: Glass of milk, bowl of soup, bread and butter, homemade cookies. 
Dinner: Lamb chop, bread and butter, spinach with egg, boiled potato, dish of 

bananas. 

In connection wi^h this exhibit, pictures were shown of actual 
scenes wherein the New York association is teaching 50,000 little 
mothers how to cook and manage other household duties. Photo- 
graphs of children properly nourished and of those improperly nour- 
ished were displayed. 



28 CONGEESS ON HYGIENE AND DEMOGRAPHY. 

In many departments of the exhibition a great manj/ charts and 
illustrative materials showing the value of the proper feeding of 
infants were exhibited. The diJfference between the natural milk 
for the baby and other forms of food was very strikingly illustrated. 
One chart from the Department of Agriculture, Bureau of Chemistry, 
showing the composition of foods for infants, made it very clear that 
no prepared food even approximated the natural breast food in its 
composition and proportion; cow's milk and goat's milk are far more 
nearly like natural human milk than any of the prepared foods on 
the market. Other charts showed food formulas for children of vari- 
ous ages. These exhibits gave a striking illustration of how modern 
science, worked out patiently in the laboratory, can be and is made 
of the utmost value in a practical way. Not only has it brought to 
our attention the great importance of proper diet, but it has put into 
the hands of the people information through the use of which they 
can combat nearly all sorts of disease. Those prepared foods, skill- 
fully advertised, making claims of being more useful even than the 
natural diet of the child, were here shown to be faulty. 

The plain lesson taught by all these charts is that the natural life 
is the sanitary life, and a mother who can not or will not nourish 
her children in the natural way has at once Umited the possibilities 
of the child not only as to its health but also as to his natural growth 
and to his general future development. 



MENTAL HYGIENE. 

The exhibit on mental hygiene was installed through the coopera- 
tion of the National Committee for Mental Hygiene (50 Union Square, 
New York City), the Connecticut Society for Mental Hygiene, the 
Illinois Society for Mental Hygiene, and the Committee on Mental 
Hygiene of the New York State Charities Aid Association. The mate- 
rial presented was arranged in six sections. Sections A and B were 
designed to show the — 

incidence of insanity and mental defectiveness in the United States and its signifi- 
cance; some explanation of the apparent increase in insanity; the cost of caring for 
the insane and the mentally defective; the relation of immigration to the incidence 
of insanity and mental defectiveness; and the effects upon the community of the 
uncared-for insane and mentally defective. 

Some of the statistics set forth in connection with this section are 
rather startHng. For example, it was stated that on the 1st of Jan- 
uary, 1910, there were 187,454 insane persons in institutions in the 
United States. This number exceeds the number of students who 
were enrolled in all colleges and universities in this country at that 
date. 



MENTAL HYGIENE. 29 

The number of patients in institutions for the insane is increasing 
at the rate of 6,000 per year. About 30,000 new cases enter our 
public and private hospitals for the insane each year, and this num- 
ber must be far below the number that deserve treatment. 

The apparent increase in insanity in this country was partly 
accounted for by the presentation of the following facts: 

The average expectation of life is longer by 10 years than it was a century ago, and 
since insanity is more often found in the middle or later periods of life, there would 
be, other things equal, relatively more people so afflicted; better standards of care 
cause more people to seek institutions for relief in the early stages of the disease; 
conditions now recognized as mental diseases were passed over previously, and those 
so afflicted were often classed merely as criminals; the death rate in institutions is 
lower now, hence the number increases. But it can not be denied that of all of the 
classes of sick people cared for in hospitals the insane is by far the most numerous. 
The number of beds provided for the insane is in excess of the combined number of 
beds provided in all other hospitals in the United States. 

The estimated cost of caring for the insane in institutions in the 
United States for the year 1910 was placed at $32,804,500, and was 
stated to be about equal to the amount expended yearly in the con- 
struction of the Panama Canal. The annual economic loss to the 
country as a result of this withdrawal of labor was estimated at 
$130,000,000. The biu*den of caring for the insane was strikingly 
illustrated by figures showing, for example, that in New York State 
nearly one-fourth (23 per cent) of the entire annual expenditure of 
State funds was appropriated last year for the care of the insane. 
Only a little more (24 per cent) was spent for the support of common 
schools and the educational department. 

The general conclusions relating to the effect of immigration on 
the prevalence of insanity were stated as follows: 

That immigration is an important source of insanity in the United States is shown 
by the fact that although the foreign bom constitute but 14.3 per cent of the general 
population, the foreign-bom insane constitute nearly 30 per cent of the insane in insti- 
tutions, and this, too, despite the fact that all ages are not represented in the foreign- 
born population, as in the case of the native born. The wise and humane control of 
immigration with reference to the exclusion of the insane and mentally defective is 
a pressing need. 

In a chart entitled ^^The children of mentally defective women'' 
it was stated that — 

The British Royal Commission reports that the offspring of mentally defective 
women are twice as numerous as the offspring of normal women. 

A helpless, feeble-minded woman is the prey of not one man but of many men. In 
the foregoing series 20 women bore 60 children by 38 fathers. Practically allsueh 
women became mothers soon after reaching the age of puberty, and most of the children 
of such women are mentally defective or illegitimate, or both. Of the above 60 children 
19 were mentally defective and 28 illegitimate. 

The unfortunate birth of such children, their helplessness, their pauperism and 
consequent ruin, are but part of a continuous series whereby the community is con- 
stantly supplied with the elements of degeneracy and crime. 



30 CONGEESS ON HYGIENE AND DEMOGRAPHY. 

Another chart: 

The effect of the mentally defective upon a community: Insane father, feeble- 
minded mother; 7 children, all mentally deficient; 1 under institutional care, 1 
married, 3 at almshouse with mother. 

Alcoholic father with imbecile brother; alcoholic mother, tuberculous sister; 8 
feeble-minded children, only 1 under institutional care. 

Feeble-minded paternal grandmother, neurotic paternal grandfather, alcoholic 
father, neurotic mother with "queer" sister; 10 children — 8 feeble-minded, 2 uncer- 
tain; 1 only under institutional care. 

The institution at Vineland, N. J., has a record of 237 similai 
families. Draw your own conclusions as to the effect of such families 
upon society and community life. It is known that 25 per cent of all 
criminals are mentally defective. 

In sections C and D material illustrating the different types of the 
nervous system, from the lower animals to that of man, was exhibited . 
The purpose of this section was to show the '' different levels at which 
the personality is vulnerable, and to illustrate by the life histories of 
actual cases of mental disease, and to indicate the way in which adjust- 
ment can be interfered with by damage to its mechanism." This 
last point was illustrated by photographs of the brain and nervous 
system in various diseased conditions. 

In this section emphasis was placed on the fact that the fatalistic 
attitude of the public toward insanity is not justifiable, for many of 
the causes are avoidable either by special measures or by strict com- 
pliance with the laws of general hygiene. The person who has not 
made some study of insanity, or who has not been informed by those 
who have made such a study, is inclined to look upon all insane 
people as if each were afflicted in the same way. There are, however, 
many varieties of insanity or insanities, each with its characteristic 
cause and varying in hopefulness or hopelessness accordingly. The 
statistics presented showed that about 25 per cent of all who are 
conunitted to insane hospitals recover and remain well. About the 
same number, while not completely cured, are able to return to their 
homes and take some part in active life. 

Section E was devoted to the methods and the results of institu- 
tional care of the insane and the mentally defective. The crude and 
horrible methods formerly used to restrain insane people were exhib- 
ited and contrasted with the freedom and lack of restraint to-day. 
An insane person is now treated as a sick person, and not as one 
possessed of a devil, as was formerly the case. It was stated that — 

The Boston Psychopathic Hospital and the Henry Phipps Psychiatric Clinic of 
Johns Hopkins University are institutions which represent the most humane idea in 
the care of mental diseases. Institutions of this character break down the last barrier 
between the treatment of the insane and the treatment of other classes of the sick. 



MENTAL HYGIENE. 31 

Section F was devoted to the campaign for mental hygiene in 
general. The recommendation was made by the national committee 
for mental hygiene that practical aid in mental hygiene should be 
given by the universities throughout the country by — 

(a) The establishment in all universities of departments for the study of the structure 
and function of the nervous system in the lower animals, so that the investigator may 
go from the simpler to the more complex phenomena of behavior. 

(6) The study of human psychology on a far broader basis than has yet been 
attempted. 

(c) The establishment of departments of mental hygiene, so the natural capacity and 
trends of students may be determined in order that their mental health may be pro- 
tected and their efficiency and chances for success increased by helping them to find 
the place in the world for which they are best adapted. 

The committee further recommended that — 

1. More attention should be given to the subject of mental diseases in medical 
schools, in order that the general practitioners may recognize cases of mental disease 
early and aid in securing treatment for them. " 

2. Institutions where early cases of insanity or those in danger of developing 
mental diseases may secure treatment, such as psychopathic hospitals and special 
wards or pavilions for the insane in .connection with general hospitals, should be 
established in many cities. 

3. Improvement of the standards of nursing the insane should be sought by pro- 
viding opportunities for training nurses and attendants, together with shorter hours, 
better wages, and better living conditions for these workers. 

4. Alcohol and syphilis, as preventable causes of mental disorders, should be 
attacked vigorously. 

5. The relation of heredity to insanity should be carefully studied. 

6. The feeble-minded should be segregated in suitable institutions, so that the 
jails, almshouses, and hospitals for the insane may be relieved of cases not subject to 
reform or cure, and that the feeble-minded may be delivered from such unsuitable 
institutions. 

7. Backward children in the public schools should be given a careful mental exam- 
ination by competent examiners, and so should all juvenile delinquents, in order 
that these classes of children may be given the right kind of work to do and, if possible, 
be placed in an environment conducive to their greatest usefulness. 

8. The relation of crime to insanity should be studied carefully, so that the legal 
aspects of the problem may be made to conform more closely to its medical aspects. 

An outline of the work of the National Committee for Mental 
Hygiene was set forth on a chart, as follows: 

The National Committee for Mental Hygiene aims to serve as a clearing house for 
the Nation on the subject of mental health, the prevention of nervous and mental 
disorders, the care and cure of the insane; and aims also to serve as a coordinating 
agency for all State and local agencies interested in these problems. 

Its activities are as follows: 

1. The National Committee for Mental Hygiene is gathering reliable data on mental 
health, the causes and prevention of nervous and mental disorders, and the care and 
treatment of the insane, and will publish and keep before the public vital facts regard- 
ing these subjects. 



32 CONGEESS ON HYGIENE AND DEMOGRAPHY. 

2. The National Committee for Mental Hygiene is gathering interesting material 
for exhibits and lectures on mental hygiene and the care and treatment of the insane, 
BO that interested workers in the several States may show the necessity for concerted 
action in behalf of the insane and the numerous portion of the public which is in 
danger of developing mental disorder. 

3. The National Committee for Mental Hygiene is enlisting the interest and sup- 
port of the public, so that all States will grant adequate appropriations for the care of 
the insane and for the proper management of the problem of mental health in their 
respective communities. 

4. The National Committee for Mental Hygiene is enlisting the support of philan- 
thropists who heretofore, because of the absence of a coordinating agency in this 
field of endeavor, have found it difficult to help the insane. This will hasten the 
day when psychopathic hospitals, psychiatric clinics in connection with medical 
schools, and special wards for the treatment of mental diseases in general hospitals 
will be established throughout the country and make it possible to treat all cases of 
incipient mental disorders promptly and with full effect. 

5. The National Committee for Mental Hygiene has published a document en- 
titled "Summaries of the laws relating to the commitment and care of the insane in 
the United States," with a view to securing uniformly good laws in all States, and 
further as a means of raising the standard of care for the insane throughout the country, 
it being an accepted fact that States with highly developed systems of care and treat- 
ment of the insane also have the best and most complete laws on the subject. 

6. The National Committee for Mental Hygiene is studying conditions among the 
insane in the United States, under the terms of a special gift of $50,000, for the purpose 
of ameliorating their condition. In order to achieve this result, plans for improve- 
ment, for the use of interested workers in given States who desire disinterested advice 
regarding their local problems, will be furnished upon application. 

7. The National Committee for Mental Hygiene will help to organize State societies 
for mental hygiene and local committees for mental hygiene throughout the ccimtry, 
so that local conditions may be improved in given States by representative groups 
of people who are vitaUy interested in the work and best qualified to manage it. 

8. The National Committee for Mental Hygiene is studying the extent and char- 
acter of the instruction given in medical schools in the United States regarding mental 
diseases, with a view to having such instruction conform to the importance of this 
subject, so that physicians generally may be able to recognize cases of incipient 
mental disorder. 

9. The National Committee for Mental Hygiene is studying the relation of immi- 
gration to the prevalence of mental diseases and defects, with a view to rendering 
aid in devising wise and humane methods in controlling the immigration of the 
insane and mentally defective. 

The chief objects, as stated and set forth in a placard, are sum- 
marized as follows: 

To .work for the protection of the mental health of the public; to help raise the 
standard of care for those threatened with mental disorder or actually ill; to promote 
the study of mental disorders in all their forms and relations, and to disseminate 
knowledge concerning their causes, treatment, and prevention. To obtain from 
every source reliable data regarding conditions and methods of dealing with mental 
disorders; to enlist the aid of the Federal Government, so far as it may seem desirable; 
to coordinate existing agencies and help organize in each State in the Union an allied 
but independent society for mental hygiene, similar to the existing Connecticut 
Society for Mental Hygiene. 



MENTAL HYGIENE. 33 

The committee on mental hygiene of the New York State Charities 
Aid Association offered an interesting exhibition by charts and maps 
illustrating their method of prevention. 

The importance of mental hygiene was emphasized in a series of 
charts setting forth, among other statements, the following: 

Mental hygiene is the study of indi\dduals with a view to determining their natural 
capacity and trends, then of assisting them first to find, and then to retain, a place in 
the world for which they are adapted. 

A nation's greatness depends upon the efficiency of its citizens; personal efficiency 
depends upon a healthy brain and nervous system and the organization of sound 
habits. 

Our conduct and thoughts depend upon the capacity of our nervous system. The 
brain is the individual — by it man lives, moves, and has his being. Education is a 
process of training the brain and nervous system by study and discipline. The aim 
of education should be to develop the capacity of these organs to the utmost. 

If a training in pedagogics gave teachers a clearer and more practical insight into 
actual Jife, as well as some appreciation of the beginning pathological tendencies of 
humanity, many failures would be avoided and many difficulties would be overcome. 

— Krafft-Ebing. 

In the section on the prevention of insanity and mental defectives 
the Minnesota School for Feeble-Minded and Colony for Epileptics, at 
Faribault, had an interesting exhibit. A large map was exhibited 
showing the location of the village comLmunity and colonies, consisting 
of training school, custodial department for women, hospitals, kitchens, 
colonies for boys, etc. Along with this were numerous photographs 
of the buildings, grounds, the workshops, hbrary, schools, gymnasiums, 
recreation halls, etc., showing how much care is being bestowed upon 
the unfortunates. Here on a farm of 1,038 acres defectives and 
epileptics are really given a better opportunity for normal Hving than 
is very often given to the healthful and more fortunate children of our 
Nation. From their school work a rather unique exhibit was shown. 
One of these illustrated the relation of mental age to abihty in sewing. 
For example the work of the normal child of 4 years is taken as a basis, 
and that of aU the defective girls who showed about the same amount 
of skill and talent, regardless of years, was classified with this. For 
example, the sewing of a girl of 19 was of such a nature as to make it 
plain that it is impossible for her to do better handwork than a normal 
child of 4 years. This fine of illustration is used up to the mental 
age of 8. It is a rather new suggestion and offers opportunity, it seems 
to me, for a new, even if crude, form of mental measurement. Natur- 
ally here, as in aU instances where the measurement of the intelligence 
is undertaken, great care and scientific carefulness must be observed. 

In a pamphlet distributed in connection with their exhibit the 
committee on mental hygiene of the New York Charities' Aid Associa- 
tion sought to answer in a brief way this question: Why should any- 



34 CONGRESS ON HYGIENE AND DEMOGRAPHY. 

one go insane? Some parts of the answer to this. question are here 
reproduced and deserve careful consideration by all people: 

CAUSES OF INSANITY. 

1. Immoral living. — One kind of insanity is known popularlj^ as "softening of the 
brain." It is known scientifically as general paralysis, or paresis. It is incurable by 
any means now known to the medical profession. * * * The very substance of the 
brain becomes changed. They usually live but a few years. It is now agreed by the 
medical profession that this disease is caused by an earlier disease known as syphilis. 
* * * If self-respect, the desire for the good opinion of others, the influence of 
religious training, and the attractions of home life are not sufficient to prevent this kind 
of wrong doing, the danger of contracting a disease which may result in incurable 
insanity should be sufficient. 

The number of patients having paresis or "softening of the brain " admitted to State 
hospitals during the year ending September 30, 1910, was 600 men, or 17 per cent of all 
men admitted, and 263 women, 8 per cent of all women admitted. 

2. Alcohol and other poisons. — ^Another group of mental diseases are due directly to 
the habitual use of alcohol. Alcoholic insanity may be brought on by the regular use of 
alcohol, even in "moderate" quantities not producing intoxication. The close rela- 
tion between alcohol and insanity has only recently been fully realized. * -^ * 
Fully 30 per cent of the men and 10 per cent of the women admitted to the State hospi- 
tals are suffering from conditions due directly or indirectly to alcohol. So marked is 
the effect of alcohol upon the brain and the nerve tissue that it helps to bring about a 
number of mental breakdowns in addition to the alcoholic insanities. 

* * * -x- * * * 

In this day of keen competition every man needs the highest possible development 
of his mental capacities. Not only is the highest mental development impossible in 
the presence of the continued use of alcohol, but impairment of the mental faculties is 
likely to follow. The children of those addicted to alcohol often start in life with 
morbid tendencies or mental defects. 

Other poisons, such as opium, morphine, and cocaine, which, with alcohol, are the 
principal parts of many patent remedies, often weaken the mental powers and produce 
insanity. 

3. Physical diseases. — Some mental breakdowns may be traced to the effects of other 
physical diseases. Typhoid fever, influenza, diphtheria, and some other diseases 
often so poison the system that, for some time after the disease itself has left, the regular 
functions of the body are seriously interfered with. 

* * * * * * * 
Overwork is often spoken of as a cause of insanity. This is not correct. Hard work 

alone rarely causes a nervous breakdown. It only becomes a menace to health when 
associated with worry and loss of sleep or causes mentioned under other headings. 
******* 

4. Mental habits. — Aside from physical causes there are also mental causes. They 
are the most important causes of some forms of insanity. The healthy state of mind is 
one of satisfaction with life. This does not depend so much upon our surroundings 
or how much money we have or how many troubles come to us, as upon the way in 
which we train ourselves to deal with difficulties and troubles. * * * Mental 
health is as important as physical health. The average person little realizes the danger 
of brooding over slights, injuries, disappointments, or misfortunes, or of lack of frank- 
ness, or of an unnatural attitude toward his feUow men, shown by unusual sensitiveness 
or marked suspicion. Yet all these unwholesome and painful trains of thought may, if 
persisted in and unrelieved by healthy interests and activities, tend toward insanity. 



SEX HYGIENE. 35 

Wholesome work, relieved by periods of rest and simple pleasures, and an interest in 
the affairs of others are important preventives of unwholesome ways of think- 
ing. * *■ * 

Our remedies oft in ourselves do lie, 

Which we ascribe to heaven. 

— Shakespeare. 

Heredity. — Most persons think that insanity may be directly inherited. This belief 
is undoubtedly wrong. One may inherit a greater or less tendency toward insanity. 
Mental instability may be inherited just as weak constitutions may be in- 
herited. * * * The most important fact in heredity is that the vast majority of 
ancestors of every individual were normal. Heredity tends, therefore, rather more 
strongly toward health than toward disease. 

The fact that heredity plays a part in the causation of insanity should create a public 
conscience regarding marriage. Marriages should not be contracted by two persons 
who have insanity or feeble-mindedness in their immediate families without seeking 
and following the advice of a competent physician. 



SEX HYGIENE. 

The exhibit which attracted by far more attention than any other 
presented was that illustrating the effects of venereal diseases and the 
work and propaganda of the American Society of Sanitary and Moral 
Prophylaxis. The section on sex hygiene, while described by one 
speaker as 'Hhe hall of horrors," will probably have a more definite 
and far-reaching educational effect than any other part of the exhibit. 
In addition to an extensive display of wax models, drawings, charts, 
and photographs, a dark room in which lectures, illustrated by lantern 
sHdes and moving pictures, were given, was in almost constant use 
throughout the whole exhibition. The great interest displayed in 
these lectures and the information disseminated in connection with 
this exhibit furnished striking evidence that at last the awful curse of 
these diseases is emerging from its veiled secrecy and that the time is 
rapidly approaching when the generations unborn will be protected 
from their baneful results. 

In the outlines presented, setting forth the general educational 
propaganda, emphasis was placed on the possibilities of teaching sex 
hygiene successfully, and with as few comphcations as possible. The 
following is the program suggested: 

I. The subject of sex hygiene must be taught as one intimately and obviously 
related to other subjects in the curriculum, such as natural history, biology, etc. To 
detach the subject of sex, and teach it to young children as an unrelated course, not 
only is illogical and unscientific, but gives it undue prominence in the childish 
mind. 

Instruction must be given in the earliest grades as a part of nature work, and should 
be carried through the eiltire social period, its complexity increasing with the growing 
demands of the child. The child should be encouraged to ask questions and make its 
own observations. 



36 CONGRESS ON HYGIENE AND DEMOGRAPHY. 

It naturally follows that the teaching should be accompanied by no more sentimen- 
tality or vagueness than any other natural history subject. 

II. At an early age a systematic attempt should be made to inculcate in the child 
a great respect for beauty and for the potential possibilities of the human body, the 
profound importance of habits, both physical and psychological, and the necessity 
for a clean, well-developed body for efficient manhood and womanhood. 

By the time the child attains puberty, he or she should have a clear general knowl- 
edge of the plan of reproduction, gained almost wholly from a study of comparative 
anatomy in an evolutionary form, from the lowest unicellular type to the complex 
vertebrates. There should also have been gained by this time a good working vocab- 
ulary. 

III. Up to the age of puberty it would seem best that sex hygiene should be taught 
by the regular class teacher, if fitted by nature for the work. Through her personal 
knowledge of the children, she should be able to distinguish the most precocious, 
and by aid of the medical inspector or, better, the parents, give the special instruction 
they demand. She should a-lso be able to distinguish those children who, by reason 
of heredity or environment, form a species of degenerates, one of whom may exert a 
most demoralizing influence upon the sex education of an entire classroom. This 
duty would also obviously necessitate very careful training on the part of the teacher. 
Such training should, therefore, be an essential part of every normal school and 
university. 

IV. Special care should be given to the pecuHar nervous and mental phenomena 
of the period of puberty. The cooperation of the medical inspector is here most 
important. Parents should be especially warned of the significance and dangers of 
this most important phase of all life. 

At this time a course in citizenship should be inaugurated, and an attempt made 
to develop an acute sense of the social and race consciousness, with the idea of pre- 
paring the child for an understanding of the sociological significance of sex. 

V. Throughout adolescence the youth is particularly sensitive to psychical and ideal- 
istic appeal. In this season, during high school and boarding school, the study of 
eugenics and heredity should be introduced, special stress being laid upon the respons- 
ibility of the present generation for the next, and upon the rights of the unborn. The 
relation of sex to all creative art, such as painting, music, and poetry, should also be 
made clear. 

At the same time, the youth, male or female, is old enough now, in the latter half of 
his high-school course, to assimilate a more technical study of the physiology of repro- 
duction, the dangers of precocity along certain lines, of masturbation, and of the vene- 
real diseases. To both boys and girls should be given a thorough course in the 
physiology and hygiene of menstruation. All of this advanced instruction would 
gain authority and dignity if given by well-trained men and women of the medical 
profession. 

VI. In the attempt, however intelligent, to deal with the sex education of chil- 
dren the teacher can not hope to meet with the desired results unless the parents 
will cooperate with the schools. 

To convince the parents of the necessity of such instruction, every means should 
be taken to arouse them to an appreciation of existing conditions. 

To this end, prepared lectures and demonstrations should be given them through 
the school centers, through parents' associations, and through women's clubs, where 
prepared literature may also be distributed. 

The detailed outlines presented, setting forth a course of work for 
teaching sex hygiene, were in part as follows; 



SEX HYGIENE. 37 

EARLY ADOLESCENCE (AGE 12-16 YEARS). 

I. Nature Study and Biology: 

1. Further study of reproduction in plants. 

2. Reproduction in the lower forms of animal life. 

(a) Species in which the care of the young is absent. 

(6) Those in which love and care of the offspring is evident. 

(c) Significance of parental love in animal life. 

(d) The mating of animals and its relation to the care of the young. 

(e) The higher the animal in scale of life, the greater the helplessness at birth 

and the more love and care needed. 
(/) The human body the most helpless of all animals, needing the greatest 
love and the longest parental protection and care. 

II. Adolescent Love: 

1. Its influence, if properly directed and controlled, can not fail of good. 

2. It should be studied as portrayed in the works of the great literary artists in 

poetry and the novel. 

3. The feeling of chivalry and honor and respect for women is to be zealously 

cultivated. Biographies of great women and knightly great men should be 
read by boys and girls. 

4. Emphasis must be laid upon the responsibility of brothers and sisters for one 

another's welfare; also by the boys' obligation to protect other boys' sisters. 

5. Expression of adolescent sex love in the form of enthusiasm for art, for altruistic 

social activities, for favorite intellectual pursuits, are to be encouraged along 
common-sense lines. 

III. Personal Hygiene: 

Hygiene and care of the reproductive organs and sex function as sacred obligations. 

1. The relation of sex control to the health of the individual and of his or her 

offspring. 

2. The danger of abuse of the sex function, and the results upon the nervous 

system, including the brain and spinal cord. 

3. The importance of properly regulated food, of exercise and play, of physical 

fatigue (not exhaustion), of mental occupation, of early rising, of cold 
bathing, of sleeping in a cold room as means of control of sex feelings. 

4. The influence of drugs (alcohol, tobacco, opium, cocaine) upon laws of sex 

control. 

5. The significance of sex in human life in the. light of plant and animal 

development as already studied. 

IV. Amusements: 

1. A careful choice of social pleasures and their environment is essential to moral 

health. 

2. The wholesome meeting of boys and girls is the only safe preliminary basis for 

mature friendships and marriages. 

3. Suggestive shows, posters, and books, also saloons and dance halls, go far 

toward nullifying the slipshod and careless home efforts, 

4. Suggestive posters and pictures make the work of the unhygienic book, theater, 

saloon, and dance hall very easy. 

LATER ADOLESCENCE (AGE 16-25 YEARS). 

I. Biology: 

1. A further study of the science of reproduction and its application to human 

life. Human embryology and heredity. 

2. Animal breeding and its influence in the production of superior qualities in 

the animals. 



38 CONGRESS OK HYGIENE AND DEMOGKAPHY. 

I. Biology — Continued. 

3. Human inheritance and its bearing on family histories. 
(a) The inevitable result of the marriage of defectives. 
(6) The inevitable result of the marriage of the most fit. 

II. Sex Hygiene: 

1. The relation of individual chastity to the moral and physical health of the 

individual and his or her unborn child. 

2. The social diseases: Their nature, contagiousness, far-reaching effects, and 

their danger to the innocent. 

III. Sociology: 

The ultimate effects of unfair social relations, of the double standard of moral and 
physical health for the two sexes, of prostitution, and of the diseases consequent 
upon immorality. 

THE METHODS OP TEACHING SEX HYGIENE. 
PERIOD OF PAEENTHOOD. 

Through an intelligent use of the family physician as the natural instructor of the 
home in sex matters. The feeling of responsibility will ennoble and furnish a new 
sanity and health to home happiness and morals. 

Through sane literature on the subject of sex hygiene, meaning by this term the 
healthy and reverent use of the sex function with a view to the future welfare of the 
individual and of his or her posterity. 

Through schools yet to be established for the deliberate, intelligent training of 
parents and school teachers. 

Through traveling exhibits, such as are possible through the instrumentality of the 
State societies of social hygiene or of the American Federation for Sex Hygiene. 

Through lectures by physicians and by others fitted by nature and by training to 
teach. 

Through deliberate measures on the part of heretofore negligent municipal and 
Federal authorities to awaken a slumbering people to the imminence of the danger 
and the means of prevention and cure. 

Through a realization of the fact that the sex function is a sacred trust, not a play- 
thing; a talent for reverent use by loyal citizens, not a means to the undermining of 
the health and life of the people. 

EXPERIMENTAL PSYCHOLOGY. 

The Cornell exhibit of experimental psychology. — The Cornell Uni- 
versity exhibit in experimental psychology contained a quantity of 
the newer apparatus that has been developed in this increasingly 
significant field of knowledge, being especially rich in apparatus for 
testing intelligence. During the exhibit the Binet test, with certain 
of the recent modifications, was applied to children, particularly for 
the purpose of illustrating a class of experiments which it is intended 
to follow out on a wider scale with the hope that they will ultimately 
lead to important conclusions. 

The relation of sense discrimination to intelligence was one of the 
subjects in which it was possible to make some experiments of inter- 
est. For this purpose there was at hand the following psychological 
apparatus: The Whipple discrimination-of-brightness apparatus — the 
ingenious dark-room box that operates by transmitted light; another 
piece of Whipple apparatus working on the principle of reflected 



SEX HYGIENE. 39 

light; the pressure-pain balance, which ascertains the point where 
mere pressure becomes pain; the sensory capacity tapping test; the 
warmth tester, wherein the influence of developed imagination is 
brought into play; etc. It is believed that ultimately tests based on 
experiments with this and similar apparatus will show more exact 
connection than is at present established between sense discrimina- 
tion and intelligence. 

In the Cornell booth there were naturally a number of exhibits of 
more definite popular interest, yet possessing educational value as 
measures of intelligence. Notable among these were the various 
'' illusions": The size-weight illusion; the relation of size, form, and 
distance; and a number of the less familiar line illusions. 



APPENDIX. 

INSTRUCTIONS RELATING TO TUBERCULOSIS, DISTRIBUTED BY THE 
DEPARTMENT OF HEALTH, NEW YORK CITY.^ 

How to keep from getting consumption.- — Keep as well as possible, for the healthier 
your body the harder for the germs of tuberculosis to grow therein. To keep healthy, 
observe the following rules: 

Avoid living, studying, or sleeping in rooms where there is no fresh air. Fresh air 
and sunlight are nature's best disinfectants and kill tubercle bacilli and other germs 
causing disease; so have as much in your room as possible. 

Do not live in dusty air; keep the rooms clean, but do not sweep or dust with dry 
brooms or cloths. Get rid of dust by cleaning with damp cloths and mops. 

Obtain fresh air by keeping one window in your bedroom partly open all night long, 
and air the room two or three times a day. 

Always wash your hands before eating, and do not put your fingers or pencils in your 
mouth or candy or chewing gum other persons have used. 

Take a warm bath with soap at least once a week. 

Do not neglect a cold or a cough, but go to a doctor or dispensary. 

How to get well if you have consumption. — If you or anyone in your family have 
tuberculosis, you should obey the following general rules if you wish to get well: 

Money spent on patent medicines or advertised consumption cures is wasted. Go 
to a doctor or dispensary. 

Do not drink whiskey or alcohol in any form. 

Do not sleep in the same bed with anyone else and, if possible, not in the same room. 

Good food, fresh air, and rest are the best medicines for consumption. 

Your windows should be kept open winter and summer, day and night. 

How to avoid giving consumption to others. — Many grown people and children have 
pulmonary tuberculosis or consumption without knowing it and can give it to others. 
Therefore every person, even if healthy, should observe the following rules: 

Do not spit on the sidewalks, playgrounds, or on the floor or hallways of your home 
or school. It spreads disease and is dangerous, indecent, and against the law. 

Always spit into a paper cup or into paper napkins or old cloths. These should not 
be used a second time, but should be at once put into a paper bag, which should later 
be burned with its contents. Pocket flasks of metal or glass may also be used. If you 
have no cup or napkin, spit in the gutter. At home use a spittoon half filled with 
water. 

Do not cough or sneeze without holding a handkerchief or your hand over your 
mouth or nose. 

A person who has pulmonary tuberculosis or consumption is not dangerous to those 
with whom he lives and works if he sleeps alone and is careful and clean. 

Rooms which have been occupied by consumptives should be thoroughly cleaned, 
scrubbed, and whitewashed, painted, or papered before they are again occupied. 
Carpets, rugs, bedding, etc., from rooms which have been occupied by consumptives, 
should be disinfected. Such articles, if the department of health be notified, will be 
sent for, disinfected, and returned to the owner free of charge, or, if he so desires, they 
will be destroyed. 

» See page 18. 
40 



INSTRUCTIONS RELATING TO TUBERCULOSIS. 41 

When consumptives move, the department of health should be notified. 

General advice to those affected. — Be hopeful and cheerful, for your disease can be 
cured, although it may take some time. 

Carefully obey your physician's instructions. You may improve steadily for 
months, and lose it all by carelessness. Improvement does not mean cure, therefore 
continue treatment as long as you are directed to do so. 

Do not talk to anyone about your disease, except your physician or nurse. 

Do not listen to tales of other patients or follow their suggestions or those of others 
concerning the treatment of your disease . 

Report to your doctor or clinic when directed. Report immediately if you have 
fever, indigestion, diarrhea, constipation, pain, increased cough, or reddish expecto- 
ration. If you are too ill to come, send word. 

If you have a hemorrhage do not become alarmed; keep quiet and notify your 
doctor or clinic. 

In the treatment of your disease fresh air, good food, and a proper mode of life are 
more important than medicines. Take no medicine that is not ordered by your 
physician. 

If you are offered admission to a sanatorium, accept at once. 

Advise any of your family, friends, or neighbors who have a persistent cough and 
have no doctor to go to the nearest tuberculosis clinic. 

Cough and expectoration. — Try to control your cough as much as possible. You 
should only cough when you have to expectorate. 

Cover your mouth with your handkerchief or hand when you have to cough. 

Your expectoration or spit contains germs and is dangerous to yourself, your family, 
and your neighbors when not properly taken care of. 

When in the house always spit into a spittoon half full of water; empty the vessel 
in the closet at least once a day and rinse it with boiling water. 

It is much better, however, to use paper handkerchiefs, which can be burned 
after use. The nurses of the department of health will supply these. 

When outdoors, spit in one of the paper handkerchiefs furnished and put it in the 
paper bag, burning bag and all on your return home. 

If you should be outdoors and have nothing with you to receive your expectoration, 
spit into the gutter. Never spit on the sidewalk. Never swallow your expectoration. 

Pure fresh air. — Stay in the open air as much as you can; if possible, in the parks, 
woods, or fields. Do not be afraid of cold water. Avoid drafts, dampness, dust, 
and smoke. Dust and smoke are worse for you than rain and snow. Don't be afraid 
of night air; it is not harmful and contains less dust than day air. 

Never sleep or stay in a hot or close room. Keep it always well ventilated. 

Keep at least one window open in your bedroom at night. 

Have a room to yourself, if possible; if not, be sure to have your own bed. 

When indoors, remain in the sunniest and best ventilated room. The room should 
preferably be without carpets; small rugs may be allowed. 

No dusting or cleaning should be done while the patient is in the room. 

Cleaning should be done only with mops or moist rags. 

Draperies, velvet furniture, and dust-catching materials should not be in the 
patient's room. 

Food and feeding. — Take a half hour's rest on the bed or the reclining chair before 
and after the principal- meals. 

Avoid eating when bodily or mentally tired, or when in a state of nervous excite- 
ment. 

Eat plenty of good and wholesome food. Besides your regular meals take a quart 
of milk daily, from three to six fresh eggs, and plenty of butter and sugar, provided 
tiiey do not disagree with you. 



42 CONGKESS ON HYGIENE AND DEMOGKAPHY. 

Eat slowly; chew your food well; avoid anything which causes indigestion. 

See that your eating utensils are thoroughly washed after use. 

Do not smoke and do not drink liquor, wine, or beer, except by special permission; 
but drink plenty of good, pure water between meal times. 

Always wash your hands thoroughly before eating, and clean your finger nails. 

Rest. — Avoid all unnecessary exertion. Never run; never lift heavy weights. 
Never take any kind of walking, breathing, or other exercises when you are tired, 
nor take them to the extent of getting tired. The kind and amount of exercise 
which you should take will be prescribed for you by your physician. 

Go to bed early and sleep at least eight hours. 

If you have to work, take every chance to rest that you can when off duty. 

When the physician prescribes a rest cure, either in bed or on a reclining chair, 
it must be carried out, either on the veranda, fire escape, roof, or in front of an open 
window. 

Clothing. — Wear underwear according to the season. Don't wear chest protectors. 

Dress comfortably and sensibly, and avoid garments constricting neck and chest. 

Keep your feet dry and warm. Wear overshoes in snowy or damp weather. 

Personal hygiene. — Keep your body clean and take a warm bath with soap once a 
week; take cold douches or cold baths according to the directions of your physician. 

Avoid all bad habits. 

Keep your teeth in good condition by brushing them regularly. 

See that your bowels move regularly every day. 

Shave your beard or wear it closely clipped. Do not kiss anyone. 

Handle the soiled personal and bed linen, especially handkerchiefs, as little as 
possible in the dry state. When soiled, place these articles in water until ready to 
be washed. 

Don't waste time or money on patent medicines or advertised cures for your disease; 
they are worthless. 

Sweeping and dusting. — In sweeping a room raise as little dust as possible, because 
dust, when breathed in, irritates the nose and throat and often sets up catarrh. Some 
of the dust breathed reaches the lungs, making portions of them black and useless. 

If the dust breathed contains the germs of tuberculosis or consumption— tubercle 
bacilli — which come from persons who have pulmonary tuberculosis spitting on the 
floors, the risk is run of getting the disease. If the sick person uses proper spit cups 
and is careful to hold a handkerchief over the mouth when coughing or sneezing, so 
as not to scatter spittle about in the air, the risk to others who live in the same rooms 
of getting the disease is inconsiderable. 

Before sweeping bare floors, sprinkle moist sawdust on the floor. When the room 
is carpeted, wet a newspaper, tear it into small scraps and scatter these over the 
carpet. In sweeping, brush these scraps of paper along with the broom, and they 
will catch most of the dust and hold it fast, just as the sawdust does on bare floors. 
Do not have either the paper or the sawdust dripping wet, only moist. 

In dusting a room, do not use a feather duster or dry cloths, because these do not 
remove the dust from the room, but only brush it into the air. 

Do all dusting with slightly moistened cloths and rinse them out in water when 
finished. 

In rooms with bare floors (in houses, stores, shops, schoolrooms, etc.), all dust can 
be easily removed after it has settled, by using a mop which has been wrung out sq 
as to be only moist, not dripping wet. 



INSTRUCTIONS RELATING TO TUBERCULOSIS. 43 

REPORT OF DISINFECTION IN A PRIVATE HOUSE. 

This certifies that the premises named herein have been fumigated, as noted, and 
in compliance with the regulations mentioned below. 

New York, July 13, 1911. 

Name of patient, John Smith. Age, 25. Disease, consumption. Duration of 
illness, 6 months. Residence, 1850 University Place. Number of rooms disinfected, 
2. Number cubic feet, 8,000. Disinfectant used: Formalin, 18 ounces; Sulphur, 

pounds. Paraform, grains. Time room left exposed to disinfectant, 

6 hours. Disinfecting solution employed, Carbolic, 2 per cent. 

Name, James Brown, M. D., 

Residence, 933 East First Street. 

In every case of disinfection the following regulations must be complied with: 

All cracks or crevices in rooms to be disinfected must be sealed or calked, to pre- 
vent the escape of the disinfectant. 

The following disinfectants may be used in the quantities named: 

Sulphur, 4 pounds for every 1,000 cubic feet, 8 hours' exposure. 

Formalin, 6 ounces for every 1,000 cubic feet, 4 hours' exposure. 

Paraform, 1 grain to every cubic foot, 6 hours' exposure. 

Carbolic acid, 2 per cent to 5 per cent solution, and bichloride of mercury, 1-1000, 
may be used for disinfecting solutions. 



PART II. ABSTRACTS OF PAPERS BEARING ON 

EDUCATION. 



RINGWORM IN THE SCHOOLS OF MEXICO. 

Dr. Manuel Uribe y Troncoso. 

Spanish Hospital, Mexico City, Mexico. 

During the school year 1910-11, 2,784 pupils were separated 
from the public schools of the City of Mexico on account of ring- 
worm. With an attendance of 34,168, this gives 8.2 per cent of 
ringworm (tinea) patients. In the municipaHties outside of the 
federal district 365 scholars were excluded from the schools, which 
gives an average attendance of 23,265 scholars, with 1.5 per cent 
of tinea patients. The disease is widely disseminated in the schools. 
Considering the great number of children with tinea and the impera- 
tive necessity of keeping them out of school so as to prevent the 
spread of the disease, it was decided to make use of the X-ray 
treatment, which reduces the duration of the old methods of depila- 
tion by tweezers from two years to two or three months. 

Two special schools were established for children affected with 
tinea, each with a capacity of about 300 scholars, and both located 
in the building occupied by the medical department. 

In this manner the sick children are constantly under observation, 
treatments are given regularly, and the progress of the depilation 
watched. Moreover, the children, being enrolled for the school year 
in their respective schools, do not lose any time, and the treatment 
as weU as the usual lessons are systematically pursued. 

The number of children enrolled in the school from January to 
March, 1911, and in the two schools for boys and girls from July, 
1911, until February, 1912, was as follows: 

Enrolled boys 284 

Enrolled girls 216 

Individual exposures to the X rays 280 

Total number of exposures 1, 165 

Children upon whom depilation took place 132 



SCHOOL DISINFECTION. 

Dr. J. T. AiNSLEE Walker. 

New York City. 

The presence of a certain proportion of infectious children in the 
school is admittedly unavoidable; the only apparently available 
weapon of defense Hes in the everyday use of spray solutions of 
44 



ABSTRACTS OF PAPERS. 45 

disinfectants to be sprinkled upon walls and desks and floors of 
schoolrooms. In addition to recognized cases of diphtlieria, measles, 
scarlet fever, and whooping cough in the schools, there always is 
a certain percentage of children who are merely carriers of disease 
germs without themselves being affected by the microorganisms 
which find lodgment within their bodies. These children are even 
a greater menace to their classmates than are the children who 
actually show visible symptoms of disease, because in the bacillus 
carriers the presence of the germ danger can not be recognized. Dis- 
infectants used in sprays are much more effective than disinfectant 
gases, because the former lay the dust in the rooms, which, after all, 
constitutes the greatest carrier of disease germs from child to child. 

Having regard to the constant recurrence of epidemics among 
school children and to the failure of aU existing preventive measures, 
routine disinfection of schoolrooms should be given a thorough trial. 
In the absence of this precautionary measure, the infective material 
diffused by children in the unrecognized stages of certain infectious 
diseases must accumulate on the schoolroom floors and constitute a 
standing menace to the health of pupils and teachers ahke. Con- 
ceding that the major part of school infection is due to direct contact, 
a certam proportion is also due to the inhalation of bacillif erous dust. 

Routine disinfection was introduced into the elementary schools 
of Great Britain in 1907. An experiment extending over a year was 
carried out by the Buckinghamshire education committee with a 
view to Qbtaining reliable data. The result showed an appreciable 
superiority in the attendance at the disinfected schools over those at 
the nondisinfected schools. 

For school dishifection, the liquid-spray method is preferable to 
that of fumigation, for three reasons. It costs less; it insures actual 
contact between the disinfectant and the infected material; and it 
prevents dust from rising. At the close of each day the classroom 
floors should be thoroughly moistened with an efl&cient germicidal 
solution, and the desks and seats wiped with a cloth wrung out of the 
same preparation. Once a week the process should be extended to 
include the walls to a height of 6 or 7 feet above the ground, and once 
a quarter the classrooms should be thoroughly sprayed from floor to 
ceiling. 

CAMPAIGN AGAINST CONTAGIOUS DISEASES OF CHILDREN. 

Dr. Walther Ewald. 
Academy of Social and Commercial Science, Frankfort, Germany. 

Contagious diseases have either yielded to modern hygiene or have 
at least been greatly affected, excepting infectious diseases of children, 
which in part only are true children's diseases. The terrible effect 



46 CONGRESS ON HYGIENE AND DEMOGEAPHY. 

of contagious diseases of children is not merely disclosed by mor- 
tality statistics, but in a general decline of young people. The battle 
can not be the same as in other infectious diseases where we have to 
proceed against bacterial components. Exciting and disseminating 
agents are rarely found in children's diseases. 

Among the characteristics of the four diseases, measles, scarlet 
fever, dipththeria, and whooping cough, are some of great importance, 
because they give hints how best to combat the disease. From an 
inquiry into morbidity and mortality by age periods we have learned 
that whooping cough is most prevalent and registers the highest 
mortality among infants, and that the other diseases appear most 
commonly between the ages of 2 and 5. If then we are to combat 
mortality in children's diseases, we must consider the fact that diseases 
intrinsically not so very dangerous may result fatally when they 
attack very young children, where rachitis exists and when they occur 
among the poor and especially in insanitary surroundings. It is 
against these conditions that we must direct our energies; we must 
isolate very young children, insist upon hygienic living quarters, and 
provide for proper feeding of infants. Either the afflicted or the unaf- 
flicted children may be isolated, and it is said that both measures have 
been resorted to in scarlet fever. It should perhaps be the duty of 
the authorities to provide living quarters for the healthy but sus- 
pected children. In diphtheria, antitoxin reduces mortality. All dis- 
eases should as far as possible be under medical treatment. In order 
to combat the diseases themselves special measures are necessary. 
An efficient agency for combating diseases might result from an 
organized special force of caretakers by keeping a record of all cases 
of sickness occurring at school. Such cases should be investigated 
and a physician consulted, and in case of necessity, brothers and sis- 
ters should be guarded against contagion. This method of protection 
might be further extended in connection with medical inspection 
of schools. In view of the large number of fatalities resulting from 
contagious diseases of children, systematic measures are necessary. 



MANAGEMENT OF TUBERCULOSIS AMONG SCHOOL CHILDREN. 

Dr. Arthur T. Cabot. 

Boston, Mass. (Died November 4, 191S.) 

Proper measures for the prevention and control of tuberculosis 
among school children should look not' only to the protection of 
children during their school life and to the cure of those that have 
active tuberculosis, but should aim at the education of all children 
in the essential facts of hygiene with, as far as possible, the cultiva- 
tion of habits of living which will protect them later in life. 



ABSTRACTS OF PAPERS. 47 

The plan of caring for feeble, anemic, and under-nourished children 
(of the class from which so many tuberculous children later develop) 
in open-air rooms, or indeed out of doors, with short hours of work 
and with extra feeding, has been so often tried and the results have 
been so satisfactory in improving the health and increasing the 
power of work, that the open-air treatment of ailing children is being 
more and more widely adopted. The benefits in health derived from 
this school work in the open air are so evident that it is hoped that 
it will be more and more supplied to the healthy as well as to the 
sick. Such provisions will meet the needs of all but the open cases 
of tuberculosis. Children with open, declared tuberculosis should be 
separated from other school children and should be constantly under 
close medical supervision. For them the recovery of their health is 
of the first importance and their schooling is of secondary considera- 
tion. Well-to-do parents can give their children proper care at home 
with such schooling as may be wise, but for the children of parents 
who can not afford this special care, some public provision must be 
made by which these children may be cared for and kept apart from 
other nontuberculous children. Two ways have been devised for 
accomplishing this: (1) Hospitals; (2) hospital schools. 

Isolation hospitals would naturally give the most complete segre- 
gation of these children, but unfortunately only a small proportion 
of the parents are willing to have their children go to a hospital. 
The result is that in a community where only hospital accommoda- 
tion is provided, the greater part of the tuberculous children go to 
the public schools, or when too sick for that they stay at home, 
spreading the infection through their family and friends. The hos- 
pital school affords less complete isolation than a hospital, but with 
a proper corps of nurses who follow the children to their homes and 
teach the parents necessary preventive measures, much in the way 
of prevention may be accomplished. 

The school has the great advantage that the parents are willing 
to send their children to it. The nurses connected with the school 
are able to follow the children to their homes and so extend the 
hygienic teaching to the parents. Upon the whole, therefore, the 
hospital school is the best means yet devised for caring for the 
already tuberculous children. 



STUDIES IN THE RELATION OF PHYSICAL INABILITY AND MENTAL DE- 
FICIENCY TO THE BODY SOCIAL. 

Dr. Isabelle T. Smart, 

Department of Education, New York City. 

The studies cover personal examinations of children reported by 
school principals and teachers as mentally defective and in urgent 
need of specialized training. Interesting data have been gained by 



48 CONGEESS ON HYGIEKE AND DEMOGKAPHY. 

study of the nationality of the various groups. Heredity and environ- 
ment are frequently evidenced in physical weaknesses as well as in 
mental defect. Alcoholism in parents produces stock degeneracy, 
both physical and mental. Sequelae of many of the contagious dis- 
eases of childhood have a marked influence on the physical and 
mental well-being of the child. 

The facts presented show the need of: 

1. Greater latitude in the arrangement of school curriculum. 

2. Greater scope in, and application of, school hygiene. 

3. The need of an increased and more comprehensive propaganda 
in the instruction of mothers and fathers in the hygiene of daily life. 

4. The absolute necessity of more school clinics and more hospital 
clinics arranged at hours to suit the needs of the school child, instead 
of, as at the present, during the hours of the school day. 

5. The urgent need of after-care committees to guard and protect, 
in so far as possible, the children who suffer in any degree from mental 
defect. 

6. The necessity for legislation to meet the present needs in the 
proper care of mental defectives and to prevent any reproduction of 
their kind. 

7. The urgent necessity of the building of more colonies, in all our 
States, for the permanent care of aments. 



EDUCATION OF IMMIGRANTS IN SCHOOL. 

Dr. William E. Chancellor, 

South Norwalk, Conn. 

The relation of teacher and pupil with special reference to the edu- 
cation of immigrants in American public schools was presented. The 
observation of children of many races and nations, a detailed study 
of 1,500 cases out of 4,000 in all, and tests covering 40 points, mostly 
scholastic, but some physiological, seem to indicate the following con- 
clusions which are submitted tentatively: 

Conclusions: Brachycephaly, mesocephaly, and dolichocephaly in 
its two forms — Mediterranean and Teutonic — each has its definite 
temperamental meaning. 

Certain races are precocious, others are normal or average, and still 
others are altricious — each of these conditions makes a temperamental 
condition as its phase or result. 

In dealing with immigrants not yet familiar with American life and 
often not speaking the English tongue, a proper relation of tempera- 
ments of pupils and teacher is far more important than elsewhere. 
The school for immigrants becomes mainly an atmosphere of social 
feeling. 



ABSTRACTS OF PAPEES. 49 

Muscular-motor young women seem to secure the best results in 
classes with great varieties of the foreign born. 

Women of the same nationality with the prevailing nationality of 
the class come as second choice. 

A certain highly sympathetic yet not excessively intellectual race, 
the Irish, and they of the female sex, bridge the gulf between the for- 
eign child and the world that he must learn. 

The work is concerned mostly with Italians, Hungarians, and Rus- 
sian Jews, in kindergartens and primary classes, and seems to indicate 
grave errors in the careless practice of the times. The great business 
of these grades is to readjust the reactions to environment, to train 
in new and far more complicated habits than the ancestry ever 
achieved, and to bring into sympathetic relations new and often 
resented ideas. Thus certain races resent the idea of the finer cour- 
tesies to women, even to their own teachers, and often to their own 
mothers and sisters. Different races, because of precocity or altricity, 
must be handled very differently in inculcating such ideas. In short, 
education is individual, and this has a far deeper meaning than current 
schooling undertakes to express. • Race temperament is one clue. 



SERVICE OF MEDICAL INSPECTION OF SCHOOLS TO THE TEACHER. 

Dr. Helen MacMurchy, 

Toronto, Canada. 

Organization. — Medical inspection of schools tends to better organ- 
ization and so increases the comfort and efficiency of the teacher and 
protects her from infection. 

New interest. — Medical inspection widens the teacher's horizon 
and brings the schoolroom into the sphere of interest of modern pre- 
ventive medicine. The average school child may be made a sanitary 
reformer and the teacher is the only one who can do it. 

Difficulties of the teacher. ~li the pupil can not hear the teacher or 
see distinctly the words, figures, etc., referred to by the teacher, then 
the efforts which should help the child are partly or wholly lost, and 
the teacher's work is rendered harder and less fruitful. Medical 
inspection, by ascertaining the condition of the general health, eyes, 
ears, etc., and leading to the cure of any defects and diseases, helps 
the teacher to do the work of the classroom. 

The teacher often feels that something must be wrong with the 
child, but either does not know what it is or fears that any attempt 
to direct the parents' attention to the defect will cause unpleasant- 
ness, or at best will not remedy the trouble. The medical inspector 
here becomes the teacher's helper, because the school physician can 



50 CONGEESS ON HYGIENE AND DEMOGEAPHY. 

not only diagnose what is wrong, but has the authority to cause it to 
be set right. 

Mentally deficient children. — These pupils are the source of much 
difficulty to the teacher, often causing disorder in the class. Medical 
inspectors should remove these children to special classes, to their 
own benefit and to the great relief of all concerned. 

The child as a human being. — Medical inspection of schools, dealing 
with each child personally, tends to impress on us the individuality 
of each child, and directs attention to his endowments of strength, 
special senses, etc. We are always trying to deal with human beings 
as soldiers, lawyers, children, women. Chinamen, or something less 
than human beings. The man or woman who is dealing with human 
beings as such (e. g., the teacher) is doing the highest kind of work. 

The teacher^ s own health. — The health of the teacher suffers chiefly 
from — (1) Impure air and infection. Diseases such as common colds, 
pneumonia, tuberculosis. (2) Eyestrain, caused by poor lighting, 
etc. (3) Nervous strain, caused by constant demands on the will 
power, patience, self-control, association with immature minds, etc. 
The dignity of the teaching profession is increased by the fact that 
by the law of the country one of the other learned professions has 
been called to the teacher's aid and authorized to use modern, scientific 
methods to prevent school infection, to improve schoolroom hygiene, 
schoolroom habits, ventilation, lighting, heating, cleaning, and the 
general morale of the classroom. Medical inspection of schools may 
be expected to improve the health of the teacher. 



FOLLOW-UP SYSTEM IN MEDICAL INSPECTION. 

Dr. Thomas A. Storey, 

College of the City of New York, New York City. 

In the department of work under the author's supervision, an 
attempt has been made to secure a method of instruction in hygiene 
which will develop permanent health habits in the individual. Med- 
ical inspection becomes a part of a method of securing information 
concerning the hygienic needs of the individual, and a basis on which 
the individual may be given advice bearing upon his personal health 
problems. 

The important feature in the plan lies in the method of following up 
instructions to the individual. The percentage of parents that refused 
to secure treatment for their children during the year ending June 1, 

1911, was seven- tenths of 1 per cent, and for the year ending June, 

1912, eight- tenths of 1 per cent. 

An outline of the routine involved in following up this instructional 
advice is given. A card-index system is employed and a '^ conference 



ABSTRACTS OF PAPERS. 51 

card" is made out and filed; another card is given to the pupil, files 
are gone over every day or two, and cases followed up. The success 
of this "follow-up" system during the year ending June 1, 1912, 
justifies the following conclusions: 

First, This method of medical inspection is effective, securing the 
repair of physical defects and correcting unhygienic conditions in 
over 90 per cent of cases. It is improving the physiological efficiency 
of at least a thousand boys every half year. 

Second. This plan of individual instruction in personal hygiene 
has met with the support of the parents of practically all of the boys. 
Such support is essential to success. 

Third. It is safe to expect that this continued personal relation- 
ship, extending throughout the high-school period and covering the 
first two collegiate years, will develop permanent habits of personal 
health control in many if not most of the boys under supervision. 



HYGIENE OF CHILDREN'S TEETH. 

William H. Potter, D. M, D., 
Professor of Operative Dentistry, Harvard University, Cambridge, Mass. 

Until recent times, an incorrect emphasis has been given to the 
functions of the teeth. Much stress has been laid upon the part which 
they play in forming an attractive facial expression and in the pro- 
duction of spoken words. Comparatively little has been said in 
regard to the necessary part which they play in the preparation of 
food, so that it can be readily digested and thoroughly assimilated, 
which secures the development and upbuilding of the body and its 
fortification against disease. If the child is to have the physical 
benefits which come from a thorough digestion and assimilation of its 
food, if it is to acquire intelligence as to the kinds and quantity of 
food which are suitable for the development of the body, sound 
teeth, properly articulated, are absolutely essential. 

Decayed and diseased teeth, on account of their defective surfaces, 
not only make a thorough treatment of the food in the mouth impossi- 
ble, but they are the means of producing, developing, and nourishing 
that which is hostile to the child's physical welfare. The pockets of 
decayed teeth harbor many bacteria of a serious sort, notably those 
of diphtheria, pneumonia, and tuberculosis. If pockets of decay 
did not exist, harmful bacteria would have a much less favorable 
resting place in the mouth; their numbers could be reduced to a 
minimum and the chance of infection also lessened. 

The actual condition of children's teeth can be best studied in our 
public schools. Examinations have shown that 70 to 90 per cent 
of all children in the public schools have defective teeth. The treat- 



52 CONGRESS ON HYGIENE AND DEMOGEAPHY. 

ment of defective teeth of children in public schools and institutions, 
whereby unclean, inefficient mouths have been made and kept clean 
and efficient, has been followed by a notable increase in the general 
physical health of the child. 

It is without question of the greatest importance that children 
have clean and healthy mouths. How can it be brought about ? 

1. In all public schools there should be careful instruction given 
as to the nature of the teeth; their uses; the diseases which attack 
them; and the methods for preventing or diminishing these diseases. 
Children and their parents should be taught that the cleaning of the 
teeth and their thorough use upon hard foods will much reduce and 
perhaps prevent decay. School-teachers must assume an oversight 
in regard to their pupils' teeth. 

2. Examinations of the teeth of all school children should be made 
at least twdce a year. 

3. Establish in school buildings school dental clinics in charge of 
dentists paid by the municipality. Add the services of a dental 
nurse, if the law makes them possible. These school clinics are to 
serve only those unable to consult a private dentist. A small fee 
should be charged in every case if possible. 

4. Begin work upon school children before serious decay has 
occurred in their permanent teeth, and continue the supervision and 
necessary repair work through the twelfth year. 



DENTAL HYGIENE FOR PUPILS OF PUBLIC SCHOOLS. 

Dr. S. Adolphus Knopf, 
New York Post-Graduate Medical School, New York City. 

The existence of bad and decayed teeth is a disease of the masses 
as much as is tuberculosis, and as such it must be combated particu- 
larly in children of school age. 

Just as we have societies for the prevention of tuberculosis, for the 
prevention of venereal diseases and alcoholism, representing the 
three great diseases of the masses, so should we have a society for 
the treatment and care of children afflicted with dental diseases. 
This society should be composed of all classes, medical and lay 
people, just as are the above-mentioned classes of societies. It 
would enable everyone who has the children's welfare at heart to 
contribute according to his means. The funds thus collected would 
materially aid to defray the expenses of taking care of the school 
children's teeth. Such a national society exists already in Austria. 
This society is composed of high officials of the Empire, statesmen, 



ABSTRACTS OF PAPERS. 53 

pedago^es, physicians, teachers, and people of all sorts of profes- 
sions and trades. 

Let us have free and partially free dental clinics; let each child be 
carefully and practically reexamined for every possible physical and 
mental deficiency; let no child pass through life with a pathological 
or esthetic defect which can be prevented by timely treatment and 
care. The result of such provision will be better health and happier 
citizens. 



UNIVERSAL SYSTEM OF MEASUREMENTS. 

Dr. Leotardo Matus Z., 

Santiago, Chile. 

It has been years since scientific studies enabled us to determine 
accurately where the best racers are bred, but as yet no system has 
been established by which we can ascertain accurately where the 
most uniformly constituted human being is found; for anthropologic 
and ethnologic studies have not yet attained perfection. The basic 
factor preventing the complete study of the human race resides 
to-day in the lack of a universal standard of measurement. 

Past congresses have been unable to determine upon the principal 
measurements to be applied to the individual. There is need of 
in^ruction in technique applied to the living person. The estab- 
lishment of a universal standard of measurements, uniform apparatus, 
and uniform method of procedure are essential. 



DEVELOPMENT OF HYGIENE IN EDUCATIONAL INSTITUTIONS. 

Prof. Dudley A. Sargent, 
Harvard University, Cambridge, 3fass. 

Physical training was first introduced into our educational institu- 
tions largely as a health measure when one or two college presidents 
and prominent educators called attention to deterioration in health 
of college students. Amherst was the pioneer college in this move- 
ment, and in 1860 appointed a professor of hygiene and physical 
education, and a few years later a number of other colleges appointed 
directors to their gymnasia. 

The students were required to attend a few lectures on physiology 
and hygiene, supplemented by required work in the gymnasium, both 
without credit. The growing athletic interest in colleges was another 
agent in establishing physical training in educational institutions. 
It was not until stimulation toward physical training was aroused 
through ambition to get into good physical condition for athletic con- 



54 CONGRESS ON HYGIENE AND DEMOGEAPHY. 

tests, or to excel in some sport or game, that our students found an 
incentive to adopt improved methods of Hving, or, in other words, 
began the practice of appKed hygiene. 

The college missed that early opportunity of placing before the 
students, through credited instruction, a vital and individual re- 
sponsibility in regard both to their own health and to that of the 
communit3^ The students, not being given a compelling object for 
which to strive, evolved their own aims through athletics. This 
hygiene interest has been evolved also among those striving to in- 
crease the efficiency of their lives from a commercial standpoint. 
Here again, the vital stimulus of necessity to be physically fit for 
labor, and to produce that labor under sanitary conditions, has 
resulted in a regard for public hygiene which the colleges have long 
ignored as an integral part of their curriculum. 

There were several causes why the college failed to recognize the 
dignity of personal hygiene in practice as well as in theory; first, the 
baneful influence of all the evils of ''professionalism;" second, the 
difficulty of getting 3^oung men of character and ability to take up 
physical training as a life work. Another factor lay in that separa- 
tion of the student body whereby one class was prone to neglect their 
mental work and carry athletics to excess, while the other was en- 
couraged by the premium put on scholarship to neglect their physical 
well-being. 

But we are learning to broaden our conception of education, espe- 
cially in realizing the bearing of physical conditions upon mental and 
moral life. Up to the year 1910 Dr. Meylan estimated that 98 per 
cent of the 136 colleges and universities in the list of the Carnegie 
Foundation had gymnasia, 94 per cent had regular instruction in 
gymnastics, and 80 per cent in athletics. In 75 per cent of these 
institutions the director of physical training is a member of the 
faculty, and in 87 per cent some form of physical training is pre- 
scribed. A recent investigation of 390 colleges, universities, mechan- 
ical and agricultural schools, etc., all over the United States shows 
that about 43 per cent of all, and 70 per cent of those that have rec- 
ognized departments of physical training, have well-defined courses 
in personal hygiene, sanitation, and public health, either connected 
with physical training, or general electives. 

The chief value, up to the present time, of physical training and 
hygiene has been in increasing the functional power of the individual. 
It now rests with our higher institutions of learning to transform that 
power from an individualistic tendency into an awakening of public 
consciousness, through realization of the iatimate connection between 
education and the demands of society. 



ABSTEACTS OF PAPEKS. 55 

TRAINING IN PERSONAL HYGIENE IN PRIVATE AND PUBLIC SCHOOLS. 

Prof. John W. Ritchie, 

College of William and Mary, Williawsburg, Va. 

Members of this congress regard hygiene as important, because 
they reahze the possibilities there are in it for mankind. School 
authorities and teachers give little attention to hygiene because they 
have no comprehension of these possibilities. We must first of all 
convince teachers that health can be earned and purchased. Noth- 
ing so quickly brings them to a reahzation of the preventability of 
disease as comparative morbidity and mortahty tables accompanied 
by simple explanations of the fundamental causes of disease. 

Systematic instruction in the principles of hygiene h necessary to 
keep pupils from becoming lost in the multitude of details. This 
instruction should be founded on a solid knowledge of the structure 
and functions of the different organs of the body, and of the prin- 
ciples governing metabolism and microbic infection. As long as the 
people of countries like the United States persistently follow hygienic 
fads and fail to discriminate between arrant quacks and reputable 
medical practitioners, it is an exceedingly short-sighted policy that 
desires to exclude from our school courses in hygiene those funda- 
mentals of anatomy, physiology, and bacteriology which throw the 
broad guiding lines through the maze of hygienic practice. 

The teaching of hygiene should be begun before the habits of the 
child are fixed. Ordinarily nothing short of a complete collapse of 
the health will shake an adult out of his accustomed habits of eating, 
sleeping, and working. Even some of the world's authorities on 
hygiene daily violate the rules they lay down for the pubhc because 
they formed their habits of living before they acquired their knowl- 
edge of hygiene. The teaching of hygiene should be begun while 
the child is yet in the plastic age, so that he can be sent out from 
school with a physical expression of his hygienic instruction in the 
habits of his life. 

Individual attention should be given to the hygienic habits of the 
child. Toothbrush clubs, fresh-air clubs, and other organized hygi- 
enic efforts are very valuable in fixing correct living habits. Much 
can be done to develop a right attitude toward hygienic questions 
and to fix the habit of properly regulating local environment by good 
hygienic conditions in the schoolroom and in the home. 



56 CONGRESS ON HYGIENE AND DEMOGRAPHY. 

THE PUBLIC SCHOOL AS A FACTOR TO LESSEN INFANT MORTALITY. 

Dr. Henry L. Coit, 

Newark, N. J. 

A comprehensive plan to check sickness and death among infants 
and young children is proposed by adding the French plan to the 
Manchester plan for ^^ Little Mothers" and providing that the '^Con- 
sultation for mothers" shall be conducted within the public school 
and finally become a part of its system. 

The best means of preventing sickness and death would be to raise 
the living power of the individual to what is called immunity. If 
we could apply this principle to infancy and childhood through 
educational and prophylactic measures, we would bring about the 
greatest possible physical efficiency in manhood and womanhood. 

While physicians have led in this crusade against infant mortality, 
it is strictly a problem in preventive medicine, and therefore clearly 
to be solved by educational methods, which should be applied by 
the people (the State), at the expense of the people, and for the 
people. 

It can not be repeated too often that the most fundamental cause 
of infant and child mortality, expressed through many channels, is 
ignorance, and the most potent influence which will destroy and 
remove it is applied knowledge. 

The instruction has, therefore, been given by private philanthropy 
in hospitals and infant welfare stations at a few isolated points and 
has been made available for comparatively few of the great mass of 
mothers who need it most. 



PHYSIOLOGICAL AGE IN EDUCATION. 

Dr. C. Ward Crampton, 
Director of Physical Training, Public Schools, New York City. 

Children should be classified according to their physiological devel- 
opment, rather than according to their school age in years. From 
birth to maturity children develop at different rates, some outstrip- 
ping others in the race, so that we find at the age of 14 about one- 
third who are already men and women, one-third in a transition 
period, and one-third quite immature. The difference between the 
mature and immature of the same age is so marked that it is aston- 
ishing that the idea of separating them for educational purposes has 
not occurred to our school authorities. The mature group are 30 to 
50 per cent heavier, 30 to 50 per cent stronger, and 10 to 15 per cent 
taller than the immature group of the same age. The mental abili- 
ties show an even more striking difference; the type of memory 



ABSTRACTS OF PAPERS. 57 

changes from rote to associative; the mental grasp is increased by 
an influx of newly ripened instincts, resulting from the change from 
an unsexual to a sexual existence. The whole attitude toward life 
becomes attached to manly or womanly thmgs, and the business of 
childhood is put behind. All these changes occur at about the time 
that the voice deepens, the second molar teeth arrive, and other 
easily recognizable signs of maturity appear. In short, of those who 
are from 12 to 15 years of age, we find some are young men and others 
are children, regardless of their ages in yesirs or progress in school- 
We find the young men with their ripened potential abilities sitting 
on the same benches, taught the same lessons, and subject to the 
same discipline as children, and the results are quite as poor as they 
would naturally be under these circumstances. The fundamental 
fact that the immature and mature are wholly different and should 
receive different educational and social treatment is disregarded. 
In the elementary school the mature do badly; in the high school, 
frankly fitted to their needs, they do 20 to 50 per cent better than 
the immature. While it is at this point the educational system on 
the inflexible basis of scholasticism and chronological age breaks 
down, it suffers from a lack of rational classification wherever mature 
and immature children are brought together in the same classroom. 



SCHOOL CHILDREN OF THE STOCK YARDS DISTRICT OF CHICAGO. 

Dr. Caroline Hedger, 

Chicago, III. 

Statistics indicate that almost 50 per cent of the children of the 
Stock Yards district showed material retardation in the two schools 
in the district from which the 200 pupils studied were taken. In the 
region in which they live the smoke comes down in clouds, and with 
it comes the smell of the fertilizer plants. This is not conducive to 
deep breathing or sound sleep, and the children impress one as lacking 
oxygen, being round-shouldered, thin, and rather pale. Statistics 
show also that the children as a whole are bad, physically, in almost 
the direct proportion as they receive insufficient food, have little 
room to live in, are forced to sleep in crowded beds, and have the 
reflected worry from taxes and mortgages. They have not the spirit 
and the nervous balance to make their grades. If the child grows 
inactive, discontented, becomes idle and criminal, is the child to 
blame ? 



^MMMMMMMnMMHMaMHHi 



BULLETIN OF THE BUREAU OF EDUCATION. 

(Continued from page 2 of cover.) 
1913. 

*No. 1. Course of study for rural school-teachers. F.Mutchler and W.J. Craig. Scents. 

No. 2. Mathematics at West Point and Annapolis. 

*No. 3. Eeport of committee on uniform records and reports. 

*No. 4. Mathematics in technical secondary schools. 

No. 5. A study of expenses of city school systems. Harlan UpdegraS, 

*No. 6. Agricultural education in secondary schools. 10 cents. 

No. 7. Educational status of nursing. M. Adelaide Nutting. 

*No. 8. Peace day. Fannie Fern Andrews. 5 cents. 

No. 9. Country schools for city boys. William Starr Myers. 

No. 10. Bibliography of education in agriculture and home economica. 

No. 11. Current educational topics, No. I. 

No. 12. Dutch schools of New Netherland and colonial New York. W. H. Kilpatrick. 

*No. 13. Influences tending to improve the work of teacher of mathematics. 5 cents. 

No. 14. Eeport of the American commissioners on the teaching of mathematics. 

No. 15. Current educational topics, No. II. 

*No. 16. The reorganized school playground. Henry S. Curtis. 5 cents. 

*No. 17. The Montessori system of education. Anna Tolman Smith. S cents. 

*No. 18. Teaching language through agriculture. M. A. Leiper. 5 cents. 

*No. 19. Professional distribution of college graduates. B. B. Burritt. 10 cents. 

*No. 20. Readjustment of a rural high school. H.A.Brown. 10 cents. 

No. 21. Urban and rural common-school statistics. H. Updegraff and W. R. Hood. 

No. 22. PubHc and private high schools. 

*No. 23. Special collections in libraries. W. D. Johnston and I. G. Mudge. 10 cents. 

No. 24. Current educational topics. No. III. 

No. 25. List of publications of the Unfted States Bureau of Education, 1912. 

No. 26. Bibliography of child study for the years 1910-11. 

No. 27. History of public-school education in Arkansas. Stephen B. Weeks. 

No. 28. Cultivating school grounds in Wake County, N. C. Zebulon Judd. 

No. 29. BibHography of teaching of mathematics. D. E. Smith and C. Goldziher. 

No. 30. Latin-American universities and special schools. Edgar Ewing Brandon. 

No. 31. Educational directory, 1912. 

No. 32. Bibliography of exceptional children and their education. A. MacDonald. 

No. 33. Statistics of State universities, etc., 1912. 

1913. 

No. 1. Monthly record of current educational publications, January, 1913. 
No. 2. Training courses for rural teachers. A. C. Monahan and R. H. Wright. 
No. 3. The teaching of modern languages in the United States. C. H. Handschin. 
No. 4. Present standards of higher education. George Edwin MacLean. 
No. 5. Monthly record of current educational pubHcations, February, 1913. 
No. 6. Agricultxiral instruction in high schools. C. H. Robison and F. B. Jenks. 
No. 7. College entrance requirements. Clarence D. Kinsley. 
No. 8. The status of rural education. A. C. Monahan. 
No. 9. Consular reports on continuation schools in Prussia. 
No. 10. Monthly record of current educational publications, March, 1913. 
No. 11. Monthly record of current educational publications, April, 1913. 
No. 12. The promotion of peace. Fannie Fern Andrews- 
No. 13. Standards for measuring efficiency of schools. G. D. Strayer. 
No. 14. Agricultm^l instruction in secondary schools. 
No. 15. Monthly record of current educational publications, May, 1913. 
No. 16. Bibliography of medical inspection and health supervision. 
No. 17. A trade school for girls. 



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